Nonsurgical Treatment Versus Surgical Treatment in Displaced Metacarpal Spiral Fractures: Extended 4.5-Year Follow-Up of a Previously Randomized Controlled Trial.

Abstract

Spiral or oblique fractures of the metacarpals of rays II-V are common and often managed nonsurgically. Surgery is typically recommended for fractures with displacement or rotational deformity. In a recent randomized controlled trial of displaced fractures, nonsurgical treatment with early unrestricted mobilization was found to be noninferior to surgical treatment at the 1-year follow-up. However, long-term outcomes comparing these approaches have not been reported. This study evaluated whether treatment differences emerge at the midterm follow-up, hypothesizing that nonsurgical treatment will remain noninferior. Of 42 patients with displaced spiral/oblique metacarpal shaft fractures enrolled in our previous randomized controlled trial, 34 were analyzed at a mean of 4.5 years postinjury (range: 3.1-6.6 years). The primary outcome was grip strength of the injured hand relative to the uninjured hand, with and without adjustment for hand dominance. Secondary outcomes included the Disabilities of the Arm, Shoulder, and Hand score, range of motion, rotational deformity, complications, and patient-rated pain. Nonsurgical treatment remained noninferior within the predefined margin. The mean grip strength was 95% of the uninjured hand in the nonsurgical group and 95% in the surgical group. After adjusting for hand dominance, the mean grip strength was 103% of the uninjured hand in the nonsurgical group and 96% in the surgical group. Secondary outcomes were similar between the groups. Nonsurgical treatment with early unrestricted mobilization remains noninferior to surgical treatment at the midterm follow-up. These findings support the viability of this treatment option for displaced single spiral or oblique metacarpal shaft fractures of rays II-V in patients who prefer nonsurgical treatment. Therapeutic II.