Surgically treated metacarpal fractures in adults: a study with 3286 cases based on the Swedish National Quality...

No international consensus regarding optimal non-surgical or surgical treatment of metacarpal fractures exists. Surgical outcome using patient-reported outcome measurements (PROMs) from national registers with large surgically treated population have rarely been reported. We present demographics and patient-reported outcomes in relation to fixation methods for surgically treated metacarpal fractures, using data from the Swedish National Quality Registry for Hand Surgery (HAKIR).

In a retrospective analysis of a prospective collected dataset, patients aged ≥ 18 years with surgically treated metacarpal fractures registered in HAKIR during 2010-2022 were included (fracture types currently unknown), excluding reoperations and fractures associated with other injuries. PROMs (QuickDASH and HQ-8 routinely used) were collected at 3 and 12 months postoperatively. Data were compared with Chi-squared, Mann-Whitney, Kruskal-Wallis or Wilcoxon signed-rank tests and PROM changes over time were expressed as effect size.

In 3,286 analyzed cases, male patients were more frequently treated than females. Males were significantly younger than females (p < 0.001). Outcome, measured with QuickDASH, showed significant improvement from 3 (median: 15.9, interquartile range [IQR]: 6.8-31.8) to 12 months (median: 8.0, IQR: 2.3-20.5) (p < 0.001) with no significant differences between fractures in thumb, fingers, and multiple fractures at 12 months. QuickDASH scores at 12 months showed no significant differences between fixation methods. Outcome between open and closed fractures did not differ. K-wire/cerclage (61%) was most frequently used fixation method (plate fixation (16%), screw fixation (11%) with a significant variation between hospitals, e.g., variation K-wire/cerclage use: 29%-80% (p < 0.001). At 12 months, only HQ-8 item weakness showed significantly better outcome for screws without plating compared to K-wire/cerclage (p = 0.048).

Based on national register data from a larger surgically treated population, good patient-reported outcome is expected one year after surgery for isolated metacarpal fractures with K-wire/cerclage being most common surgical fixation method. Despite notable national variation in fixation methods, likely influenced by currently unknown fracture types and possibly other confounding factors, no overall differences in outcome based on the PROM QuickDASH were observed. However, less weakness was noted 12 months postoperatively following screw fixation.