Comparative outcomes in fifth metacarpal neck fractures: Meta-analysis and GRADE evaluation of the evidence.
TL;DR
Although no significant difference was noted in grip strength and shortening, there was statistically significant palmar angulation in patients treated conservatively, and future studies with uniform functional outcome measurements must establish unambiguous clinical guidelines for treating 5MCN fractures.
Abstract
Purpose
Despite the high incidence of 5th metacarpal neck (5MCN) fracture, the literature lacks concise information about the ideal treatment option. This review aimed to compare the functional outcome of conservative and operative management of 5MCN fractures.
Methods
The electronic databases PubMed and Scopus were used for the literature review. This review is intended to include all original studies comparing the outcomes of 5MCN fractures that were managed operatively and conservatively.
Results
The final inclusion of 5 eligible studies was based on full-text screening. A total of 311 patients were analyzed from the included five studies, with a majority of males (178/203, 83.7%). Significant reduction in palmar angulation (SMD -1.23, 95% CI -2.21 to -0.25) was noted in surgical group as compared to the conservative group. No significant difference was noted in terms of grip strength (SMD 0.96, 95% CI -2 to 3.98) or shortening (SMD 1.65, 95% CI: -2.39 to 5.69) in both the groups.
Conclusion
Although no significant difference was noted in grip strength and shortening, there was statistically significant palmar angulation in patients treated conservatively. The vocation and expectations of each patient should be carefully considered before deciding on the course of treatment. Future studies with uniform functional outcome measurements must establish unambiguous clinical guidelines for treating 5MCN fractures.