title: Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures.
abstract: BACKGROUND
  Fifth metacarpal fractures are common and comprise a significant proportion of traditional orthopaedic fracture clinic workload. We reviewed the functional outcome and the satisfaction of patients managed with a new protocol that promoted "self-care" and resulted in the discharge of most of these patients from the emergency department with no further follow-up.
  
  
  METHODS
  A retrospective study was performed of patients discharged with a fifth metacarpal fracture between April 2012 to October 2012. A postal questionnaire was sent to each patient, followed by a telephone call. Patient-reported outcome measures (EQ-5D, QuickDASH) and patient satisfaction were assessed. Of the 167 patients eligible for the study, 5 were excluded. Of the remaining 162, 64 were uncontactable or declined to participate. The mean follow-up time was 21.6 months (SD 1.9, range 18.1 to 24.7).
  
  
  RESULTS
  The median EQ-5D health index score was 0.87 (IQR 0.74 to 1.00), and the median QuickDASH score was 2.3 (IQR 0 to 6.8). Seventy-nine (80.6 %) patients were satisfied with the outcome of their injury, while 83 (84.9 %) reported being satisfied with the process. There was no difference between those with a fracture or those without a fracture in EQ-5D (p = 0.307) or QuickDASH (p = 0.820).
  
  
  CONCLUSIONS
  Fifth metacarpal fractures can be managed effectively through an Emergency Department protocol without any formal orthopaedic follow-up. This pathway lead to excellent patient-reported outcome measures and patient satisfaction. This protocol has reduced unnecessary hospital attendances for patients and increased the time available for clinicians to deal with more challenging injuries.
authors.affiliation: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF UK.
authors.forename: David
authors.initials: D
authors.lastname: Gamble
authors.affiliation: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF UK.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Jenkins
authors.affiliation: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF UK.
authors.forename: Martyn J
authors.initials: MJ
authors.lastname: Edge
authors.affiliation: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF UK.
authors.forename: Alisdair
authors.initials: A
authors.lastname: Gilmour
authors.affiliation: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF UK.
authors.forename: Iain C
authors.initials: IC
authors.lastname: Anthony
authors.affiliation: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF UK.
authors.forename: Margaret
authors.initials: M
authors.lastname: Nugent
authors.affiliation: Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF UK.
authors.forename: Lech A
authors.initials: LA
authors.lastname: Rymaszewski
keywords: Fracture; Fracture clinic redesign; Metacarpal; Virtual fracture clinic