The Utility of Plain Films for Nonoperative Fifth Metacarpal Fractures: Are Follow-up Radiographs Necessary?

• Published in: Hand (New York, N.Y.) Vol. 13; no. 6; pp. 646 - 651
• Main Authors: Heckmann, Nathanael, Dusch, Marie N., Pannell, William C., Bauschard, Michael, Alluri, Ram K., Sivasundaram, Lakshmanan, Ghiassi, Alidad
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-11-2018
• Subjects: Bone Nails; Clinical Decision-Making; Closed Fracture Reduction; Fracture Fixation; Fractures, Bone - diagnostic imaging; Fractures, Bone - therapy; Humans; Metacarpal Bones - diagnostic imaging; Metacarpal Bones - surgery; Open Fracture Reduction; Retrospective Studies; Surgery; postoperative imaging; boxer’s fracture; metacarpal fracture
• ISSN: 1558-9447; 1558-9455
• DOI: 10.1177/1558944717733278

Background: Fifth metacarpal fractures are often treated nonoperatively with serial radiographs; however, the utility of these radiographs in altering clinical management has not been investigated. We hypothesize that follow-up plain films will not alter clinical management and are therefore unnecessary for most patients. Methods: Between 2007 and 2014, patients with a fifth metacarpal fracture at our level I trauma center were retrospectively reviewed. Patients with inadequate documentation or imaging, ipsilateral upper extremity injuries, or who underwent initial surgical fixation were excluded. Initial and postreduction radiographs were reviewed by 4 board-certified attending hand surgeons and 2 hand fellows who indicated their preferred management. At a later date, blinded to their initial management, the reviewers assessed follow-up films taken at least 2 weeks later and indicated their preferred management. Results: In total, 60 patients met inclusion criteria, and of those, 30 were randomly selected. There were 9 base, 7 shaft, and 14 neck fractures. Initially, reviewers opted for nonoperative management in 72.2% of base, 71.4% of shaft, and 91.7% of neck fractures. After reviewing follow-up films, reviewers changed from nonoperative to operative management in 0.0% of base, 9.5% of shaft, and 1.2% of neck fractures. Conclusions: Follow-up radiographs may not be indicated for most fifth metacarpal base and neck fractures. Follow-up radiographs may change management in select fifth metacarpal shaft fractures as these fractures may displace. Follow-up radiographs should be performed at the discretion of the treating surgeon on an as-needed basis for fractures at risk for displacement.