Is casting superior to plate fixation in metacarpal shaft fractures?

Objectives: This study aimed to compare the outcomes and conduct a cost analysis between plate screw fixation and conservative treatment. Patients and methods: The retrospective study was conducted with 36 patients (32 males, 4 females; mean age: 30.3 +/- 13.4 years; range, 16 to 65 years) between May 2019 and July 2023. The patients were divided into two groups: those who underwent surgery with miniplate fixation (n=21) and those who were conservatively managed (n=15). The differences in postoperative shortening and angulation were compared between these groups. Additionally, the patients' postoperative functional scores, complication rates, examination findings, and cost analyses were compared. Results: The per-patient cost in the surgical group was higher than in the conservatively treated group (<euro>246.96 vs. <euro>45.07; p<0.001). While postoperative shortening and angulation were more pronounced in the nonoperative group, the other clinical parameters and functional scores were improved. The return-to- work time was longer in the nonoperative group due to prolonged immobilization. Conclusion: Nonoperative splint treatment for metacarpal shaft fractures shows better radiological and clinical outcomes than surgery, except for angulation and shortening, which have limited impact on function. Due to higher costs in surgical cases, nonoperative treatment is more cost-effective. Larger, randomized trials are needed to confirm these findings.