Management of paediatric fifth metacarpal neck fractures: a systematic review

Abstract

Background: Fifth metacarpal neck fractures (FMCNFs) are common among paediatric patients. Complications include reduced metacarpophalangeal (MCP) range of motion and grip strength, which impede the hand’s functional abilities. Various management options are available, but indications are not standardised. This systematic review aims to assimilate all available evidence on the management of paediatric FMCNFs to determine appropriate treatment pathways. Methods: PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures. Results: Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9–17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°–33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°–54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°–58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes. Conclusions: This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management.