title: Long-term follow-up of unoperated, nonscissoring spiral metacarpal fractures.
abstract: BACKGROUND
  Spiral metacarpal fractures can result in shortening of the metacarpal shaft, which may lead to extension lag at the metacarpophalangeal joint and reduced grip strength. These fractures have been surgically treated to restore metacarpal length; however, there are complications associated with surgery, postoperative management and wound healing, which further threaten power recovery in the hand.
  
  
  OBJECTIVE
  To determine the effect of conservative management of un-operated, nonscissoring spiral metacarpal fractures.
  
  
  METHODS
  Sixty-one consecutive patients presenting with nonscissoring spiral metacarpal fractures were treated nonoperatively and studied prospectively to determine the natural history of their power outcome. Thumb fractures and those requiring surgical intervention for scissoring were excluded.
  
  
  RESULTS
  Follow-up data of a minimum of five months (mean follow-up 87 weeks) were available for 13 patients. Mean grip strength at final follow-up was 36.18 kg on the uninjured side and 36.58 kg on the injured side. The strength-difference values did not differ significantly from zero (P=0.72).
  
  
  CONCLUSIONS
  The loss of metacarpal length associated with these fractures may not cause a power deficit sufficiently large to significantly affect grip strength and functional recovery in the hand. A prospective randomized controlled trial of operated versus unoperated, nonscissoring metacarpal fractures is warranted.
authors.affiliation: University of Ottawa, Ottawa, Ontario;
authors.forename: Brittany B
authors.initials: BB
authors.lastname: Macdonald
authors.affiliation: Department of Plastic Surgery, Saint John Regional Hospital, Saint John, New Brunswick;
authors.forename: Amanda
authors.initials: A
authors.lastname: Higgins
authors.affiliation: Department of Plastic Surgery, Saint John Regional Hospital, Saint John, New Brunswick;
authors.forename: Susan
authors.initials: S
authors.lastname: Kean
authors.affiliation: Department of Plastic Surgery, Saint John Regional Hospital, Saint John, New Brunswick;
authors.forename: Carolyn
authors.initials: C
authors.lastname: Smith
authors.affiliation: Department of Plastic Surgery, Saint John Regional Hospital, Saint John, New Brunswick; ; Dalhousie University, Halifax, Nova Scotia.
authors.forename: Donald H
authors.initials: DH
authors.lastname: Lalonde
keywords: Conservative management; Grip strength; Nonscissoring; Power; Spiral metacarpal fracture; Unoperated