Are there concepts in treatment of metacarpal fractures? Own results and areview of the literature of last 12 years

As the treatment of metacarpal fractures is today still a controversial sub ject, we conducted an analysis of the literature in order to present the di fferent therapy guidelines, indications, and their results. The data from t he follow-up of 1602 patients was taken from literature which dated from 1 January 1984 to 31 March 1996. A total of 522 patients who underwent surger y received K-wires, screws or external minifixateur. The conservative appro aches ranged from immobilization to Various methods of mobilization with di fferent aids or without fixation of the fracture. The mobilization in a bra ce provided good to excellent-results in 95% of the cases; however, the fai lure rate of therapy was 23% because of local bruises and skin necrosis (3% ). The mobilization with handcast, tape etc, attained good to excellent res ults in 94% of the cases. Here, no complications occurred. Both the immobil ization treatment and the surgery provided good to excellent results in 85% of the cases. The reposition of fractures of the fifth metacarpal was succ essful in only 15% of the cases. Fractures with dislocations below 30 degre es, a shortening of less than 5 mm, no rotational displacement or that belo w 10 degrees, no articular incongruency, and no relevant soft tissue trauma do not need surgery according to our results and should be treated with ea rly mobilization as suggested by the survey. Beyond these limits a primary surgical therapy is justified. The immobilization of metacarpal fractures o ver a period of more than 3-4 weeks is not necessary.