Is Routine Outpatient Follow-up Required in Fifth Metacarpal Neck Fractures?

Aim: To investigate the factors affecting the healed angulation in patients treated with closed reduction and casting for a fifth metacarpal neck fracture. Materials and Methods: The study consisted of sixty-three patients with a fifth metacarpal neck fracture, who had an angulation <30(degrees) after initial reduction. All the patients were treated with closed reduction and casting. The patients were divided into two groups according to the healing angulation (<= 30 and >30(degrees) as groups 1 and 2, respectively). The angles of the fifth metacarpal neck fracture were measured at presentation, after reduction, and at the final follow-up visit. Results: Of the sixty-three patients, thirty healed with acceptable angulation (Group 1) and thirty-three with unacceptable angulation (Group 2). There was not a statistically significant difference between two groups according to the mean age, follow-up time, metacarpophalangeal cast angle, wrist extension cast angle, and correction angle. The mean initial fracture angulation was 41.7(degrees)+/- 12.9(degrees) (9(degrees)-70(degrees)) in Group 1 and 48.3(degrees)+/- 9.9(degrees)(29(degrees)-70(degrees)) in Group 2 (p=0.049). The mean fracture angulation after the reduction was 15.5(degrees)+/- 8.9(degrees) (0-30(degrees)) in Group 1 and 26(degrees)+/- 4.8(degrees) (15(degrees)-30(degrees)) in Group 2 (p<0.001). The mean final follow-up healing angulation was 20.8(degrees)+/- 7.4(degrees) (3(degrees)-30(degrees)) in Group 1 and 39.6(degrees)+/- 5.7(degrees)(31(degrees)-55(degrees)) in Group 2, respectively (p<0.001). As a result of the ROC curve analysis, the cut-off values were found as >44(degrees) and >17(degrees) for unacceptable result of initial and postreduction angulations, respectively. Conclusion: In the patients with fifth metacarpal neck fracture treated with closed reduction and casting, the initial angle <44(degrees) and the angulation after reduction <17(degrees)are positive indicators for functional recovery. Routine follow-up may not be required in this group of patients.