Metacarpal Fracture Trends in Treatment: A Matched Cohort Analysis of 1022 Patients

Objectives: The goals of this study were twofold: first, to assess epidemiologic characteristics of metacarpal fractures including patient and fracture characteristics; second, to investigate the most common treatment strategies employed. Methods: Patients presenting to a single large academic practice with an isolated acute metacarpal fracture were retrospectively reviewed. Baseline demographics and fracture-specific data were collected. Two investigative arms of the study were then delineated. In the first arm, patient groups were matched based on metacarpal involvement between operative and nonoperative cohorts and CPT-stratified data was independently assessed and grouped based on frequency. In the second arm, a non-matched analysis was performed to assess management strategies and relative frequency of varying techniques. Results: After matching, 1022 patients were included in the first investigational arm. Fractures of the fifth metacarpal were most common. Most operative fractures were located at the metacarpal shaft (43.2%), whereas those managed nonoperatively were most found at the metacarpal neck (38.2%). In the second investigational arm, the four most common CPT codes were 26600 (closed management without manipulation), 26615 (open reduction and internal fixation), 26608 (closed reduction and percutaneous pinning), and 26605 (closed management with manipulation) in descending order. 97.2% of patients undergoing ORIF underwent plate and screw fixation. Conclusion: Most metacarpal fractures were found to have been managed nonoperatively. When treated operatively, metacarpal fractures were more often treated with open reduction and internal fixation rather than closed reduction and pinning. Most patients were treated with a plate and screw construct in favor of an intramedullary screw. Level of evidence: III