Nice RCT Changes the Game on Metacarpal Shaft Fractures

A "most-viewed" article in JBJS is worth revisiting

Nice RCT Changes the Game on Metacarpal Shaft Fractures

What’s the Claim?

A small but robust randomized clinical trial found that surgery for closed, displaced and/or shortened, diaphyseal spiral or oblique metacarpal fractures of one finger was no better than immediate, unrestricted mobilization (with or without an optional resting splint) in terms of:

  • Mean grip strength as a percentage of the contralateral, uninjured hand
  • Rotational deformities, total active motion, or flexion/extension deficit
  • Patient-reported outcomes, including pain under load, DASH score, satisfaction, or cosmetic appearance

Patients treated without surgery took far less sick leave, incurred much lower costs of care, and had no unplanned operations (while 3 of 20 in the surgical group had unplanned reoperations).

(Editor's Note: This article was published about a year ago, but made the rounds again recently as one of JBJS’s “most-viewed” articles, so we felt it worth covering here. It is available in full-text form.)

How’s It Stack Up?