Three cast techniques for the treatment of extra-articular metacarpal fractures. Comparison of short-term outcomes and final fracture alignments.
BACKGROUND
Most extra-articular metacarpal fractures can be managed nonoperatively. While the conventional wisdom is that the metacarpophalangeal joint should be immobilized in a position of flexion, alternative methods for cast immobilization have been described. The purpose of this study was to retrospectively evaluate three methods of closed treatment; specifically, we investigated whether the position of immobilization of the metacarpophalangeal joint or the absence of a range of motion of the interphalangeal joints affected the short-term outcome or fracture alignment.


METHODS
Between November 2000 and April 2004, extra-articular metacarpal fractures were immobilized for five weeks in one of three ways: with the metacarpophalangeal joints in flexion and full interphalangeal joint motion permitted (Group 1); with the metacarpophalangeal joints in extension and full interphalangeal joint motion permitted (Group 2); and with the metacarpophalangeal joints in flexion, the interphalangeal joints in extension, and no interphalangeal joint motion permitted (Group 3). Radiographs and the range of motion were evaluated at five weeks after application of the cast, and the range of motion and grip strength were assessed at nine weeks.


RESULTS
Two hundred and sixty-three patients met the inclusion criteria. At five weeks, there was no difference among the treatment methods with regard to the range of motion or the maintenance of fracture reduction. At nine weeks, there was no significant difference with regard to the range of motion or grip strength.


CONCLUSIONS
When immobilization was discontinued by five weeks, the position of the metacarpophalangeal joints and the absence or presence of interphalangeal joint motion during the immobilization had little effect on motion, grip strength, or fracture alignment. This finding contradicts the conventional teaching that the metacarpophalangeal joint must be immobilized in flexion to prevent long-term loss of joint extension. Patient comfort, ease of application, and the surgeon's familiarity with the technique should influence the choice of immobilization.


METHODS
Therapeutic Level III.
Tavassoli
Jeff
J
Bone and Joint/Sports Medicine Institute, Charette Health Sciences Center, 620 John Paul Jones Circle, Portsmouth, VA 23708, USA. cjhogan@mar.med.navy.mil
Ruland
Robert T
RT
Hogan
Christopher J
CJ
Cannon
David L
DL
D000293:Adolescent; D000328:Adult; D002370:Casts, Surgical; D017102:Fracture Healing; D050723:Fractures, Bone / Q000628:therapy*; D018737:Hand Strength; D006801:Humans; D007103:Immobilization / Q000379:methods; D008349:Manipulation, Orthopedic / Q000379:methods*; D008662:Metacarpophalangeal Joint; D008663:Metacarpus / Q000293:injuries*; D008875:Middle Aged; D016059:Range of Motion, Articular