Incidence and Predictors of Loss of Reduction in Fifth Metacarpal Neck Fractures

Fifth metacarpal neck fractures are among the most common hand injuries and are frequently managed nonoperatively. While closed reduction using the Jahss maneuver can acutely improve fracture alignment, prior studies suggest that these improvements are often not maintained. This study aimed to quantify radiographic improvements following reduction and identify predictors of reduction loss at early follow-up.

A retrospective cohort study was conducted at a tertiary academic center from 2015 to 2022. Patients with isolated fifth metacarpal neck fractures treated with the Jahss maneuver and splinting were included. Radiographic angulation was measured prereduction, immediately postreduction, and at first follow-up. Demographic, clinical, and injury characteristics were analyzed using nonparametric and categorical tests to identify predictors of reduction loss (P < .05).

Of 108 patients, 91 (84%) returned for follow-up. The median age was 23 years; 82% were male. Mean angulation improved from 40.5° prereduction to 35.0° postreduction (P < .001), with ≥5° correction achieved in 38% of patients. At follow-up, 43% experienced loss of reduction, with mean angulation increasing to 38.7° (P < .001). Greater initial angulation (P = .017) and larger immediate correction (P < .001) were significantly associated with reduction loss. Patient age, sex, mechanism (punching vs accidental trauma), alcohol involvement, and repeat injury were not associated with reduction loss (all P > .05).

While the Jahss maneuver provides immediate radiographic improvement, reductions are frequently not maintained during early healing, particularly in fractures with greater initial deformity or large immediate correction. Given that most fractures met acceptable alignment criteria without intervention, routine reduction may offer limited long-term benefit.