Management of extra-articular fractures of the fifth metacarpal: Operative vs. Non-opeRaTive TrEatment (FORTE) – A systematic review and meta-analysis

Journal article

Aims: Extra-articular fifth metacarpal fractures are treated operatively and non-operatively without consensus. We aim to establish whether there are differences in patient-reported outcome, objective clinical outcome and adverse events for skeletally mature patients with closed extra-articular fractures of the 5th metacarpal that are treated operatively versus non-operatively. Patients: Skeletally mature patients with closed, extra-articular 5th metacarpal fractures. Methods: A systematic review and meta-analysis of randomised controlled trials using methodology adapted from the Cochrane Handbook for Systematic Review of Interventions and compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PROSPERO CRD42018091633) Results: Two trials of 5th metacarpal neck fractures met the inclusion criteria and were included in the final pooled analysis (n = 125). There were no significant differences in patient-reported, objective clinical or radiographic outcomes between the operative and non-operative groups at 12 months. Operatively managed patients reported greater time off work and were more likely to suffer an adverse event. Conclusion: Existing trial data is limited and inconclusive in terms of patient-reported outcome measures. Given that there remains wide variation in the treatment of these common injuries around the world, there is a need for further high-quality evidence to guide clinical practice.

Authors: Wormald, JCR; Claireaux, HA; Gardiner, MD; Jain, A; Furniss, D

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: JPRAS Open
• Volume: 20
• Pages: 59-71
• Publication date: 2019-02-15
• Acceptance date: 2019-02-04
• DOI: 10.1016/j.jpra.2019.02.001
• EISSN: 2352-5878
• Language: English
• Keywords: FFR