From the Guidelines
No treatment is needed at this time as the fracture is already healed and the deformity is modest. The findings indicate a healed fracture of the fifth metacarpal bone with some mild deformity. The fracture has healed with a slight forward (volar) curvature, which is a common outcome for this type of injury. According to the American College of Radiology Appropriateness Criteria 1, radiography is the initial imaging modality of choice for suspected acute hand and wrist trauma, and a standard 3-view radiographic examination of the hand is usually sufficient to detect fractures and dislocations of the metacarpals and phalanges. In this case, the joints in the hand appear normal with good spacing, suggesting normal function should be possible. There are no foreign objects detected in the soft tissues. This type of deformity after healing is common in fifth metacarpal fractures (often called "boxer's fractures") and typically doesn't cause significant functional problems. Some key points to consider in the management of this condition include:
- The modest deformity noted is unlikely to require surgical correction unless it's causing pain or limiting hand function.
- Regular use of the hand for normal activities should be encouraged to maintain strength and mobility.
- Further imaging or evaluation may be necessary if symptoms persist or worsen over time, but currently, the fracture appears to be well-healed.
From the Research
Findings and Impression
The given findings indicate an old healed fracture of the fifth metacarpal diaphysis with mild posttraumatic deformity and some volar curvature. The joint spacing throughout the hand looks well preserved, and no opaque foreign body is seen within the soft tissues. The impression is that of a healed fifth metacarpal fracture with resultant modest deformity.
Follow-up and Treatment
- The necessity of follow-up visits after fracture treatment is a topic of discussion among orthopedic surgeons and researchers 2, 3.
- A study found that most surgeons follow up patients with lower extremity extra-articular fractures radiographically for 3-6 months and clinically for 6 months, and slightly longer for intra-articular fractures 2.
- Another study suggested that routine follow-up visits after internal fixation of proximal femoral fractures may not be necessary, as they do not result in changes in treatment plans 3.
- The use of physical therapy (PT) after lower extremity fracture repair is also an area of interest, with orthopedic surgeons and physical therapists differing in their opinions on rehabilitative needs 4.
Patient Compliance and Follow-up
- Patient compliance with follow-up visits is an important aspect of orthopedic care, and factors such as distance traveled, age, sex, and insurance status can influence attendance 5.
- A study found that younger age, male sex, Black or African American race, self-pay, Medicaid insurance, and increased distance were individual predictors of missing an appointment 5.
- Implementing interventions to improve follow-up rates and patient outcomes may be beneficial, especially for patients considered at high risk of being lost to follow-up 5.