Skip to main content
NCBI home page
Plastic and Reconstructive Surgery Global Open logoLink to Plastic and Reconstructive Surgery Global Open
. 2022 Jan 25;10(1):e4065. doi: 10.1097/GOX.0000000000004065

A Fourteen-year Review of Practice Patterns and Evidence-based Medicine in Operative Metacarpal Fracture Repair

Daniel C Sasson *, Nikhil D Shah *, Selcen S Yuksel *, Aaron M Kearney *, Keith Brandt †, Arun K Gosain *,✉
PMCID: PMC8849433  PMID: 35186624

Background:

The American Board of Plastic Surgery has been collecting practice data on metacarpal fracture operative repair since 2006 as part of its Continuous Certification process. These data allow plastic surgeons to compare their surgical experience to national trends. Additionally, these data present the opportunity to analyze those trends in relation to evidence-based medicine.

Methods:

Data on metacarpal fracture operative repair from May 2006 to December 2014 were reviewed and compared with those from January 2015 to March 2020. National practice trends observed in these data were evaluated and reviewed alongside published literature and evidence-based medicine.

Results:

In total, 1160 metacarpal fracture repair cases were included. Outpatient (as opposed to inpatient) operative repairs have been trending upward, from 50% to 61% (P < 0.001). Most repairs were performed under general anesthesia (68%), and there was a decrease in the use of regional anesthesia between our two cohorts (14%–9%; P = 0.01). An open reduction with internal fixation was the most popular technique (51%), and a decrease in the use of closed reduction with splinting was observed (16%–10%; P = 0.001). Stiffness was the most commonly reported adverse event. Topics addressed in evidence-based medicine articles but not tracer data included interosseous wiring, which has shown success in spiral shaft fracture treatment with minimal complications, and nonoperative management.

Conclusion:

As evidence-based recommendations continue to change with additional research inquiry, tracer data can provide an excellent overview of the current practice of metacarpal fracture repair and how effectively physicians adapt to remain aligned with best practices.

Takeaways

Question: Do plastic surgeons increasingly adhere to evidence-based practices in metacarpal fracture operative repair?

Findings: Repairs from 2006 to 2014 were reviewed/compared with those from 2015 to 2020. Most were performed under general anesthesia (68%), and there was a decrease in the use of regional anesthesia (14%–9%; P = 0.01). A decrease in the use of closed reduction with splinting was observed (16%–10%; P = 0.001).

Meaning: It can be concluded that most board-certified plastic surgeons are practicing within EBM guidelines.

INTRODUCTION

The American Board of Plastic Surgery (ABPS) diplomates submit procedure logs twice every 10 years to maintain Continuous Certification. The ABPS has identified 24 tracer procedures, subdivided into four modules (Comprehensive, Cosmetic, Craniomaxillofacial, and Hand). Plastic surgeons report 10 consecutive cases of one of the tracer procedures of their choice. Data collected include patient medical history, preoperative physical examination, operative details, and surgical outcomes (herein referred to as “tracer” data).

The ABPS has collected tracer data on metacarpal fracture operative repair since 2006. These data allow plastic surgeons to compare their surgical experience with national trends. Additionally, these data present the opportunity to analyze those trends in relation to evidence-based medicine. Here, we will compare tracer data for metacarpal fracture operative repair and its concurrence or discordance with evidence-based recommendations on the topic. This analysis will be split into three categories: “Pearls,” or topics covered by evidence-based medicine and the ABPS tracer, research topics not covered by the ABPS tracer, and tracer elements collected that have not yet been assessed in the literature (suggested future research directions).

METHODS

ABPS tracer data for metacarpal fracture operative repair were reviewed from May 2006 to March 2020. The data were divided into two groups: May 2006–December 2014 and January 2015–March 2020, to evaluate national trends. Comparisons between time points were performed using the chi-square test.

Clinical “pearls” were selected after a comparative review of tracer data with published plastic surgery literature, with particular respect to maintenance of certification reviews.1–3 Evidence-based data present in the literature but not collected by the ABPS, and the converse, were examined for future research direction, focusing on improving patient outcomes.

RESULTS

The ABPS Continuous Certification database contained information on 1160 metacarpal fracture operative repair cases from May 2006 to March 2020. An estimated 510 cases were reported from May 2006 to December 2014 and 650 from January 2015 to March 2020. The average patient age was 29 years, and 78% identified as men (Table 1). Thirty-three surgeons participated from 2006 to 2014, and 30 surgeons participated from 2015 to 2020. In total, 76% of surgeons were employed privately. On physical examination, 87% of fractures were closed. Most fractures (48%) presented on the bone shaft, followed by the neck (24%). Fractures of the fifth metacarpal and fourth metacarpals were most common (52% and 32%, respectively). In terms of fracture pattern, 43% were transverse, 38% oblique, and 33% comminuted. Rotational deformity (scissoring) was reported in 34% of patients. An estimated 95% of patients had no additional soft-tissue injury. An estimated 20% of patients experienced more than one metacarpal fracture.

Table 1.

Patient Demographics and Preoperative Evaluation

2006–2014 2015–2020 Overall P
# % / Avg # % / Avg # % / Avg
1. Age (y) x̅ = 28 x̅ = 30 x̅ = 29
n = 510 n = 650 n = 1160
SD = 15 SD = 18 SD = 17
1.1 Practice type (surgeons) 0.612
Academic practice 7 8 15 24%
Private practice 26 22 48 76%
2. Gender
Men 403 79% 496 76% 899 78%
Women 107 21% 154 24% 261 23%
3. Medical history
a. Smoker
Yes 111 22% 134 21% 245 21%
No 339 66% 486 75% 825 71%
b. Occupation
Light 104 20% 136 21% 240 21%
Medium 99 19% 140 22% 239 21%
Heavy 46 9% 76 12% 122 11%
c. Operated hand
Right dominant 316 62% 440 68% 756 65%
Right nondominant 12 2% 10 2% 22 2%
Left dominant 36 7% 29 4% 65 6%
Left nondominant 122 24% 153 24% 275 24%
d. Associated injuries
Skin loss 32 6% 41 6% 73 6%
Tendon 18 4% 34 5% 52 4%
Artery 5 1% 7 1% 12 1%
Nerve 10 2% 25 4% 35 3%
Bone 135 26% 185 28% 320 28%
e. Days between injury and first evaluation Average = 6
f. No. days between injury and surgery Average= 9
g. Worker’s compensation for this injury
Yes 33 6% 38 6% 71 6%
No 384 75% 511 79% 895 77%
4. Physical examination
a. Fracture type 0.422
Open 47 9% 75 12% 122 11%
Closed 453 89% 561 86% 1014 87%
b. Location
Head: intraarticular 20 4% 24 4% 44 4% 0.839
Head: extraarticular 21 4% 21 3% 42 4% 0.422
Neck 115 23% 168 26% 283 24% 0.194
Shaft 257 50% 302 46% 559 48% 0.141
Base: intraarticular 72 14% 83 13% 155 13% 0.503
Base: extraarticular 57 11% 81 12% 138 12% 0.502
c. Digit
Thumb 62 12% 75 12% 137 12% 0.746
Index 55 11% 69 11% 124 11% 0.926
Middle 74 15% 97 15% 171 15% 0.844
Ring 153 30% 215 33% 368 32% 0.041*
Small 269 53% 334 51% 603 52% 0.645
d. Fracture pattern
Transverse 243 48% 252 39% 495 43% 0.002*
Oblique 193 38% 245 38% 438 38% 0.958
Spiral 54 11% 67 10% 121 10% 0.877
e. Comminution 0.030*
Yes 150 29% 228 35% 378 33%
No 329 65% 370 57% 699 60%
f. Rotational deformity (scissoring) 0.009*
Yes 152 30% 247 38% 399 34%
No 309 61% 338 52% 647 56%
g. More than one metacarpal fractured 0.871
Yes 97 19% 131 20% 228 20%
No 402 79% 504 78% 906 78%
Open in a new tab

*P < 0.05; P values indicate comparisons between 2006 and 2014, and between 2015 and 2020 groups.

Between May 2006 and 2014, the average duration from initial injury to repair was reported to be 9 days (Table 1). Outpatient (as opposed to inpatient) operative repairs have been trending upward, from 50% to 61% (P < 0.001) (Table 2). The most popular operative technique was an open reduction with internal fixation (51%), and most patients experienced no postoperative adverse events (85%) (Tables 2, 3). Metacarpal stiffness was the most commonly reported adverse event; however, the tracer did not inquire how many degrees of range of motion were lost. Patients (85%) and their physicians (84%) were overall satisfied with procedural outcomes (Table 3).

Table 2.

Surgical Treatment Plan

2006–2014 2015–2020 Overall P
# % / Avg # % / Avg # % / Avg
I. Operation location and time
1. Location <0.001*
Hospital inpatient 95 19% 107 16% 202 17%
Hospital outpatient 253 50% 399 61% 652 56% <0.001*
Accredited freestanding outpatient facility 120 24% 68 10% 188 16%
Accredited office operating room (AAAASF or JCAHO or CAAASF) 16 3% 26 4% 42 4%
2. Incision to dressing surgery time (min) for metacarpal fracture surgery x̅ = 51 x̅ = 51 x̅ = 51
3. Tourniquet used 0.379
No 160 31% 180 28% 340 29%
Yes 316 62% 427 66% 743 64%
4. Tourniquet time (min) x̅ = 38 x̅ = 41 x̅ = 40
II. Surgical treatment plan
1. Reduction
Closed reduction, splinting 83 16% 63 10% 146 13% 0.001*
Closed reduction, percutaneous pinning 121 24% 182 28% 303 26% 0.100
Closed reduction percutaneous lag screw 1 0% 1 0% 2 0% 0.863
External fixator 2 0% 6 1% 8 1% 0.278
Open reduction and internal fixation† 259 51% 336 52% 595 51% 0.759
†Plate fixation 57 11% 58 9% 115 10% 0.202
†Lag screw(s) 35 7% 43 7% 78 7% 0.867
Other 59 12% 86 13% 145 13% 0.396
2. Perioperative Antibiotics
a. No. perioperative doses of antibiotics 0.402
None 110 22% 115 18% 225 19%
One 319 63% 421 65% 740 64%
More than one 53 10% 76 12% 129 11%
b. More than one day of antibiotics 0.508
No 284 56% 376 58% 660 57%
Yes 174 34% 220 34% 394 34%
Open in a new tab

*P < 0.05; P values indicate comparisons between 2006 and 2014, and between 2015 and 2020 groups.

†Operative technique is a subset of open reduction and internal fixation.

table 3.

Outcomes and Adverse Events

2006–2014 2015–2020 Overall P
# % / Avg # % / Avg # % / Avg
1. No. nights in hospital x̅ = 1 x̅ = 1 x̅ = 1
2. Time out of work (wk) x̅ = 4 x̅ = 5 x̅ = 4
3. Postoperative adverse events
None 425 83% 558 86% 983 85% 0.237
Wound separation treated conservatively 3 1% 2 0% 5 0% 0.469
Infection requiring oral antibiotics only 7 1% 8 1% 15 1% 0.832
Infection requiring IV antibiotics 2 0% 3 0% 5 0% 0.858
Injury to tendon 0 0% 3 0% 3 0% 0.124
Injury to nerve 0 0% 0 0% 0 0%
Injury to artery 0 0% 0 0% 0 0%
Nonunion 3 1% 7 1% 10 1% 0.372
Malunion 9 2% 3 0% 12 1% 0.029*
Decreased range of motion of MCP joint 28 5% 35 5% 63 5% 0.937
Complex regional pain syndrome 2 0% 2 0% 4 0% 0.808
Readmission to the hospital 3 1% 2 0% 5 0% 0.469
Plate/screw removal† 10 2% 14 2% 24 2% 0.819
Tenolysis† 3 1% 5 1% 8 1% 0.712
Capsulotomy† 3 1% 5 1% 8 1% 0.712
Other 33 6% 31 5% 64 6% 0.208
4. Movement outcomes
Almost full range of motion 316 62% 402 62% 718 62% 0.968
Good range of motion 83 16% 151 23% 234 20% 0.003*
Poor range of motion 20 4% 16 2% 36 3% 0.155
No movement 1 0% 0 0% 1 0% 0.259
Tenolysis required 2 0% 3 0% 5 0% 0.858
Don’t know—patient did not return for follow up 67 13% 65 10% 132 11% 0.095
Other 29 6% 31 5% 60 5% 0.484
5. Patient satisfaction with end results 0.091
Satisfied 418 82% 563 87% 981 85%
Dissatisfied 6 1% 5 1% 11 1%
6. Physician satisfaction with end result 0.007*
Satisfied 410 80% 565 87% 975 84%
Dissatisfied 29 6% 20 3% 49 4%
Open in a new tab

*P < 0.05; P values indicate comparisons between 2006 and 2014 and between 2015 and 2020 groups.

†Reoperation required.

DISCUSSION

Pearls

Anesthesia

EBM

No experimental evidence has been described in the literature to support a specific anesthetic modality in metacarpal fracture repair. Therefore, practice patterns are likely due to surgeon and anesthesiologist training, patient preference, and the extent of the injury.

Tracer

Reported data indicate an increase in general anesthesia from 62% to 73% (P < 0.001), as well as a decrease in brachial plexus block specifically (regional anesthesia) from 14% to 9% (P = 0.01) (Table 4). However, the high proportion of general anesthesia is likely confounded by the larger proportion of complex (multiple fingers, comminuted, etc.) injuries in the dataset relative to the fractured population, which nearly always require surgical intervention.

Table 4.

Anesthesia Plan

2015–2020 2015–2020 Overall P
# % / Avg # % / Avg # % / Avg
1. Anesthetic type
Local anesthetic only injected in affected area without sedation 41 8% 42 6% 83 7% 0.301
Local anesthetic only injected in affected area with sedation 15 3% 29 4% 44 4% 0.178
Regional anesthesia (brachial plexus block) 69 14% 58 9% 127 11% 0.013*
Regional anesthesia (Bier block) 8 2% 7 1% 15 1% 0.462
General anesthesia 316 62% 473 73% 789 68% <0.001*
Use of epinephrine in hand for hemostasis 11 2% 29 4% 40 3% 0.033*
Open in a new tab

*P < 0.05; P indicate comparisons between 2006 and 2014, and between 2015 and 2020 groups.

Surgical Treatment Plan

EBM (Nonfirst Metacarpal Fracture)

The majority of metacarpal fractures can be treated nonoperatively (described as closed reduction, splinting).4–9 This is the case for most fifth metacarpal neck and other minimally displaced shaft fractures when rotational deformity is not a concern. In their review, Wong and Higgins report that nonoperative reduction is generally not attempted in their practice due to the difficulty maintaining a nonfixed reduction and the good functional outcomes without doing so.3

When excessive displacement is present and necessitates open operative treatment, intermetacarpal pinning or intramedullary fixation (utilizing nail or Kirschner wire) is preferred to provide stability without disrupting extensor tendon function.3 Superiority has not been established between anterograde and retrograde intramedullary fixation techniques.10–15 Intramedullary fixation is additionally favored for significantly angulated metacarpal neck fractures lacking rotational deformity. In contrast, plate fixation or interfragmentary (lag) screw fixation is preferred in significantly angulated shaft fractures.16–18 Low-profile plates have been utilized to minimize obstruction to surrounding soft tissues; however, no significant difference in outcome from plate thickness has been ascertained. The use of absorbable plates has been described as well; however, metal plates remain the gold standard.19

In open fractures, Kirschner wire fixation is the preferred operating modality where soft-tissue healing is of concern.11 When bone loss is present, locking plate fixation is favored to maintain alignment and length.16,20,21 In the most severe cases where bone loss or soft-tissue compromise is present, external fixation techniques may be used.22,23

Additional operative approaches with nonspecific indications include closed reduction and percutaneous pinning with Kirschner wires, as well as open reduction and internal fixation with miniplates.24

EBM (First Metacarpal Fracture)

Consensus exists among the literature that first metacarpal fractures be treated operatively in almost all cases to avoid trapeziometacarpal joint displacement and ultimately, adduction contractures.

Bennett fractures with fragments of significant size should be treated openly with interfragmentary (lag) screw fixation.17 In cases where the fragment size is insufficient to allow for screw fixation, closed (fluoroscopic) reduction with percutaneous pinning between the larger metacarpal base segment and trapezium can be utilized.24

Given fracture fragments of sufficient size, locking miniplate fixation can be utilized for comminuted first metacarpal base fractures.25 If the fragment area is insufficient, external fixation between the distal metacarpal and trapezium should be used.26 Additional operative approaches with nonspecific indications include open reduction and internal fixation, and intermetacarpal pinning.27

Tracer

Open reduction and internal fixation was reported as the most commonly utilized operative modality (51%) (Table 2). This is in concurrence with EBM recommendations for its use as a primary surgical technique. As reported, these data encompass intermetacarpal pinning, intramedullary fixation, and open Kirschner wire fixation. Plate fixation and interfragmentary (lag) screws were far less commonly used in open reduction at 10% and 7%, respectively. Closed reduction with percutaneous pinning, the standard for first metacarpal fractures was reported as the second most common technique, although these fractures ranked low in prevalence in the present data (12%).28 External fixation was reported to be a highly uncommon procedure in practice (1% of repairs) and is not a suggested repair method for any metacarpal by the literature (Table 2).

Nonoperative treatment (described as closed reduction, splinting) was reported in relatively low proportion and has been trending downward from 16% to 10% (P < 0.001) (Table 2). This is likely because tracer data focus on patients that are categorized to have undergone a surgical procedure.

Perioperative Antibiotics

EBM

Meta-analyses have demonstrated no significant difference in infection rates following single-dose versus multiple-dose prophylactic antibiotic administration. A cost-effectiveness approach may be more constructive in developing an optimal antibiotic strategy.29

Tracer

Surgeons tended to prescribe one perioperative dose of antibiotics (64%) or none at all (19%) (Table 2). However, a significant proportion (34%) of patients received multiple days of antibiotics in the postoperative period, likely related to the injury’s severity. Without further information, these data remain discordant with evidence-based practices.

Infection

EBM

Surgical wound infections of closed fractures are relatively rare.29 Percutaneous and external methods have the highest risk of infection due to the continued exposure to epidermal bacterial flora.30

Tracer

Infection was an uncommon complication (~1%), with no trend (Table 3).

In Literature but not in Tracer

The literature commonly differentiates between first and nonfirst surgical techniques and recommendations for metacarpal fractures. However, the tracer data do not provide the same differentiation. In addition, nonoperative management of metacarpal fractures may be underreported in the tracer data since data entry focuses on operative cases done during the ABPS Continuous Certification process. Several operative techniques have been grouped in the tracer and relegated to “other” (Table 2). These include interosseous wiring, which has shown success in spiral shaft fracture treatment with minimal complications.31 Lastly, perceived pain is often reported in the literature but is not specifically collected in the tracer.30,32,33

Future Research Directions

Detailed tourniquet use is missing from the literature but is reported to be used in over 64% of procedures (Table 2).34 Additionally, no specific evidence-based studies have been identified that compare different rehabilitation methods following metacarpal fracture treatment. In total, 23% of patients reported an incomplete range of motion following surgery; thus, studies to determine a specific rehabilitation protocol would be largely beneficial (Table 3). Most authors currently recommend early active motion.17,18,35,36 Successful petitioning for workers’ compensation is reported in the tracer, but no actionable conclusions can be found in the literature beyond its effect on recovery profile (Table 1).37

The ABPS did not collect information regarding nonsurgical treatments. Including this information in a future tracer database would add significant value to analyses of trends and adherence to best practices. Lastly, per-patient tracer information would allow for analysis more specific to patient and treatment variables, allowing for comparison between components such as practice outcomes specific to practice type, antibiotic usage outcomes, and comorbidity effects on patient prognosis.

CONCLUSIONS

The metacarpal fracture operative repair tracer data allow practicing plastic surgeons to compare their surgical inclinations and techniques with national trends from board-certified plastic surgeons and EBM. Additionally, it can be concluded that most board-certified plastic surgeons are practicing within EBM guidelines. As these recommendations continue to change with additional research inquiry, tracer data can provide an excellent overview of the current practice of metacarpal fracture repair and how effectively physicians adapt to remain aligned with best practices.

ACKNOWLEDGMENTS

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.

Footnotes

Published online 25 January 2022.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

REFERENCES

  • 1.Friedrich JB, Vedder NB. An evidence-based approach to metacarpal fractures. Plast Reconstr Surg. 2010;126:2205–2209. [DOI] [PubMed] [Google Scholar]
  • 2.Bloom JMP, Hammert WC. Evidence-based medicine: metacarpal fractures. Plast Reconstr Surg. 2014;133:1252–1260. [DOI] [PubMed] [Google Scholar]
  • 3.Wong VW, Higgins JP. Evidence-based medicine: management of metacarpal fractures. Plast Reconstr Surg. 2017;140:140e–151e. [DOI] [PubMed] [Google Scholar]
  • 4.Jones NF, Jupiter JB, Lalonde DH. Common fractures and dislocations of the hand. Plast Reconstr Surg. 2012;130:722e–736e. [DOI] [PubMed] [Google Scholar]
  • 5.Liverneaux PA, Ichihara S, Hendriks S, et al. Fractures and dislocation of the base of the thumb metacarpal. J Hand Surg Eur Vol. 2015;40:42–50. [DOI] [PubMed] [Google Scholar]
  • 6.Diaz-Garcia R, Waljee JF. Current management of metacarpal fractures. Hand Clin. 2013;29:507–518. [DOI] [PubMed] [Google Scholar]
  • 7.Ben-Amotz O, Sammer DM. Practical management of metacarpal fractures. Plast Reconstr Surg. 2015;136:370e–379e. [DOI] [PubMed] [Google Scholar]
  • 8.Harris AR, Beckenbaugh RD, Nettrour JF, et al. Metacarpal neck fractures: results of treatment with traction reduction and cast immobilization. Hand (N Y). 2009;4:161–164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Khan A, Giddins G. The outcome of conservative treatment of spiral metacarpal fractures and the role of the deep transverse metacarpal ligaments in stabilizing these injuries. J Hand Surg Eur Vol. 2015;40:59–62. [DOI] [PubMed] [Google Scholar]
  • 10.Lee SK, Kim KJ, Choy WS. Modified retrograde percutaneous intramedullary multiple Kirschner wire fixation for treatment of unstable displaced metacarpal neck and shaft fractures. Eur J Orthop Surg Traumatol. 2013;23:535–543. [DOI] [PubMed] [Google Scholar]
  • 11.Kim JK, Kim DJ. Antegrade intramedullary pinning versus retrograde intramedullary pinning for displaced fifth metacarpal neck fractures. Clin Orthop Relat Res. 2015;473:1747–1754. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Doarn MC, Nydick JA, Williams BD, et al. Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: short term results. Hand (N Y). 2015;10:314–318. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Ruchelsman DE, Puri S, Feinberg-Zadek N, et al. Clinical outcomes of limited-open retrograde intramedullary headless screw fixation of metacarpal fractures. J Hand Surg Am. 2014;39:2390–2395. [DOI] [PubMed] [Google Scholar]
  • 14.del Piñal F, Moraleda E, Rúas JS, et al. Minimally invasive fixation of fractures of the phalanges and metacarpals with intramedullary cannulated headless compression screws. J Hand Surg Am. 2015;40:692–700. [DOI] [PubMed] [Google Scholar]
  • 15.Corkum JP, Davison PG, Lalonde DH. Systematic review of the best evidence in intramedullary fixation for metacarpal fractures. Hand (N Y). 2013;8:253–260. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Omokawa S, Fujitani R, Dohi Y, et al. Prospective outcomes of comminuted periarticular metacarpal and phalangeal fractures treated using a titanium plate system. J Hand Surg Am. 2008;33:857–863. [DOI] [PubMed] [Google Scholar]
  • 17.Soni A, Gulati A, Bassi JL, et al. Outcome of closed ipsilateral metacarpal fractures treated with mini fragment plates and screws: a prospective study. J Orthop Traumatol. 2012;13:29–33. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18.Tan JS, Foo AT, Chew WC, et al. Articularly placed interfragmentary screw fixation of difficult condylar fractures of the hand. J Hand Surg Am. 2011;36:604–609. [DOI] [PubMed] [Google Scholar]
  • 19.Dumont C, Fuchs M, Burchhardt H, et al. Clinical results of absorbable plates for displaced metacarpal fractures. J Hand Surg Am. 2007;32:491–496. [DOI] [PubMed] [Google Scholar]
  • 20.Agarwal AK, Pickford MA. Experience with a new ultralow-profile osteosynthesis system for fractures of the metacarpals and phalanges. Ann Plast Surg. 2006;57:206–212. [DOI] [PubMed] [Google Scholar]
  • 21.Souer JS, Mudgal CS. Plate fixation in closed ipsilateral multiple metacarpal fractures. J Hand Surg Eur Vol. 2008;33:740–744. [DOI] [PubMed] [Google Scholar]
  • 22.Langford MA, Cheung K, Li Z. Percutaneous distraction pinning for metacarpophalangeal joint stabilization after blast or crush injuries of the hand. Clin Orthop Relat Res. 2015;473:2785–2789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Dailiana Z, Agorastakis D, Varitimidis S, et al. Use of a mini-external fixator for the treatment of hand fractures. J Hand Surg Am. 2009;34:630–636. [DOI] [PubMed] [Google Scholar]
  • 24.Potenza V, Caterini R, De Maio F, et al. Fractures of the neck of the fifth metacarpal bone. Medium-term results in 28 cases treated by percutaneous transverse pinning. Injury. 2012;43:242–245. [DOI] [PubMed] [Google Scholar]
  • 25.Mumtaz MU, Farooq MA, Rasool AA, et al. Unstable metacarpal and phalangeal fractures: treatment by internal fixation using AO mini-fragment plates and screws. Ulus Travma Acil Cerrahi Derg. 2010;16:334–338. [PubMed] [Google Scholar]
  • 26.Houshian S, Jing SS. Treatment of Rolando fracture by capsuloligamentotaxis using mini external fixator: a report of 16 cases. Hand Surg. 2013;18:73–78. [DOI] [PubMed] [Google Scholar]
  • 27.Greeven AP, Alta TD, Scholtens RE, et al. Closed reduction intermetacarpal Kirschner wire fixation in the treatment of unstable fractures of the base of the first metacarpal. Injury. 2012;43:246–251. [DOI] [PubMed] [Google Scholar]
  • 28.Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am. 1992;23:19–33. [PubMed] [Google Scholar]
  • 29.Slobogean GP, Kennedy SA, Davidson D, et al. Single- versus multiple-dose antibiotic prophylaxis in the surgical treatment of closed fractures: a meta-analysis. J Orthop Trauma. 2008;22:264–269. [DOI] [PubMed] [Google Scholar]
  • 30.Moon SJ, Yang JW, Roh SY, et al. Comparison between intramedullary nailing and percutaneous K-wire fixation for fractures in the distal third of the metacarpal bone. Arch Plast Surg. 2014;41:768–772. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 31.Al-Qattan MM. The use of a combination of cerclage and unicortical interosseous loop dental wires for long oblique/spiral metacarpal shaft fractures. J Hand Surg Eur Vol. 2008;33:728–731. [DOI] [PubMed] [Google Scholar]
  • 32.Zemirline A, Lebailly F, Taleb C, et al. Arthroscopic assisted percutaneous screw fixation of Bennett’s fracture. Hand Surg. 2014;19:281–286. [DOI] [PubMed] [Google Scholar]
  • 33.Uludag S, Ataker Y, Seyahi A, et al. Early rehabilitation after stable osteosynthesis of intra-articular fractures of the metacarpal base of the thumb. J Hand Surg Eur Vol. 2015;40:370–373. [DOI] [PubMed] [Google Scholar]
  • 34.Feldman G, Orbach H, Rinat B, et al. Internal fixation of metacarpal fractures using wide awake local anesthesia and no tourniquet. Hand Surg Rehabil. 2020;39:214–217. [DOI] [PubMed] [Google Scholar]
  • 35.Strub B, Schindele S, Sonderegger J, et al. Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur Vol. 2010;35:725–729. [DOI] [PubMed] [Google Scholar]
  • 36.Facca S, Ramdhian R, Pelissier A, et al. Fifth metacarpal neck fracture fixation: locking plate versus K-wire? Orthop Traumatol Surg Res. 2010;96:506–512. [DOI] [PubMed] [Google Scholar]
  • 37.Rudbeck M, Johansen JP, Omland Ø. A follow-up study on return to work in the year after reporting an occupational injury stratified by outcome of the workers’ compensation system. J Occup Environ Med. 2018;60:542–547. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Plastic and Reconstructive Surgery Global Open are provided here courtesy of Wolters Kluwer Health

RESOURCES