Management of extra-articular fractures of the fifth metacarpal: Operative vs. Non-opeRaTive TrEatment (FORTE) – A systematic review and meta-analysis. (June 2019)

• Record Type: Journal Article
• Authors: Wormald, JCR; Claireaux, HA; Gardiner, MD; Jain, A; Furniss, D; Costa, ML
• Is Part Of: JPRAS open. Volume 20(2019)
• Page Start: 59
• Page End: 71
• Publication Date: 2019-06
• Subjects: Hand surgery -- Trauma -- Fracture -- Systematic review; Surgery, Plastic -- Great Britain -- Periodicals; 617.9505
• DOI: 10.1016/j.jpra.2019.02.001
• Languages: English
• ISSNs: 2352-5878

Abstract

Summary: Aims: Extra-articular fifth metacarpal fractures are treated operatively and non-operatively without consensus. We aim to establish whether there are differences in patient-reported outcome, objective clinical outcome and adverse events for skeletally mature patients with closed extra-articular fractures of the 5th metacarpal that are treated operatively versus non-operatively. Patients: Skeletally mature patients with closed, extra-articular 5th metacarpal fractures. Methods: A systematic review and meta-analysis of randomised controlled trials using methodology adapted from the Cochrane Handbook for Systematic Review of Interventions and compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PROSPERO CRD42018091633) Results: Two trials of 5th metacarpal neck fractures met the inclusion criteria and were included in the final pooled analysis ( n = 125). There were no significant differences in patient-reported, objective clinical or radiographic outcomes between the operative and non-operative groups at 12 months. Operatively managed patients reported greater time off work and were more likely to suffer an adverse event. Conclusion: Existing trial data is limited and inconclusive in terms of patient-reported outcome measures. Given that there remains wide variation in the treatment of these common injuries around the world, there is a need for further high-quality evidence to guide clinical practice.