Conservative treatment has comparable outcome with bouquet pinning of little finger metacarpal neck fractures: a multicentre randomized controlled study of 85 patients

Current literature gives few guidelines regarding indication for operative treatment of little finger metacarpal neck fractures, and some surgeons choose operative treatment when the palmar angulation exceeds 30 degrees. The objective of this study was to determine whether conservative treatment produces comparable outcomes with bouquet pinning in a randomized, controlled trial. Eighty-five patients with little finger metacarpal neck fractures with 30 degrees palmar angulation in the lateral view were included. Patients were randomized to two groups: conservative treatment without reduction of the fracture (43 patients); and closed reduction and bouquet pinning (42 patients). After 1year, there were no statistical differences between the groups in QuickDASH score, pain, satisfaction, finger range of motion, grip strength, or quality of life. There was a trend versus better satisfaction with hand appearance (p=0.06), but longer sick leave (p<0.001) and more complications (p=0.02) in the operative group. Level of evidence: Level 2