Is casting superior to plate fixation in metacarpal shaft fractures?
Orhun Eray Bozkurt1
, Ugur Bezirgan2, Erdinc Acar3, Osman Talha Nergizal4, Ebru Dumlupinar5, Mehmet Armangil6
1Department of Orthopedics and Traumatology, Division of Hand Surgery, Kulu State Hospital, Konya, Türkiye
2Department of Orthopedics and Traumatology, Division of Hand Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye
3Department of Orthopedics and Traumatology, Division of Hand Surgery, Bilkent City Hospital, Ankara, Türkiye
4Department of Orthopedics and Traumatology, Ankara University Faculty of Medicine, Ankara, Türkiye
5Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Türkiye
6Department of Orthopedics and Traumatology, Division of Hand Surgery, Ankara University Faculty of Medicine, Ankara, Türkiye
Keywords: Cost analysis, metacarpal shaft fractures, nonoperative treatment, plate screw fixation, surgical treatment.
Abstract
Objectives: This study aimed to compare the outcomes and conduct a cost analysis between plate screw fixation and conservative treatment.
Patients and methods: The retrospective study was conducted with 36 patients (32 males, 4 females; mean age: 30.3±13.4 years; range, 16 to 65 years) between May 2019 and July 2023. The patients were divided into two groups: those who underwent surgery with miniplate fixation (n=21) and those who were conservatively managed (n=15). The differences in postoperative shortening and angulation were compared between these groups. Additionally, the patientsʼ postoperative functional scores, complication rates, examination findings, and cost analyses were compared.
Results: The per-patient cost in the surgical group was higher than in the conservatively treated group (€246.96 vs. €45.07; p<0.001). While postoperative shortening and angulation were more pronounced in the nonoperative group, the other clinical parameters and functional scores were improved. The return-towork time was longer in the nonoperative group due to prolonged immobilization.
Conclusion: Nonoperative splint treatment for metacarpal shaft fractures shows better radiological and clinical outcomes than surgery, except for angulation and shortening, which have limited impact on function. Due to higher costs in surgical cases, nonoperative treatment is more cost-effective. Larger, randomized trials are needed to confirm these findings.
Citation: Bozkurt OE, Bezirgan U, Acar E, Nergizal OT, Dumlupinar E, Armangil M. Is casting superior to plate fixation in metacarpal shaft fractures? Jt Dis Relat Surg 2025;36(1):182-192. doi: 10.52312/ jdrs.2025.1983.
Performed the analysis, collected the data, wrote the paper: O.E.B.; Wrote the paper, collected the data: U.B.; Performed the analysis, contributed data or analysis tools: E.A.; Performed the analysis, collected the data: O.T.N.; Performed the analysis and statistics: E.D.; Conceived and design the analysis: M.A.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The data that support the findings of this study are available from the corresponding author upon reasonable request.