Conservative treatment for closed fifth (small finger) metacarpal neck fractures

A closed (the overlying skin remains intact) fifth metacarpal neck fracture occurs when the bone is broken just below the knuckle of the little finger. These account for approximately one in five of all hand fractures. The typical patient is a young man who sustained this injury, which is often called a boxer's fracture, as a result of throwing a punch. Currently, there is no consensus concerning the best way to treat these fractures, which because they are common and affect a mainly working-age population have important economic consequences. Usually they are treated without surgery. Conservative or non-surgical treatment generally involves fracture reduction, where the bone fragments are put back into place, followed by immobilisation by various means (e,g, plaster cast, splint, brace or strapping of adjacent fingers) and to various extents, including none at all. If one particular treatment method could be shown to be superior to all others in terms of functional outcome or allow earlier return to work, then the economic impact of this would be considerable. By examining the evidence from randomised controlled trials, this review aimed to answer “which treatment results in the best functional outcome in adults?”. Other outcomes of interest sought included pain, time to return to work and cosmetic outcome.

Five small studies, which included a total of 252 patients, met the inclusion criteria. Most studies were of poor quality and the patient numbers were small and none reported on hand function. There was no evidence that any of the treatments under test was significantly superior. Based upon current evidence, no single conservative method for fracture of the neck of the fifth metacarpal can be recommended as superior to another. Recovery though was generally excellent whichever method of treatment was used.

Authors' conclusions: 

No included studies reported our primary outcome measure of interest, validated hand function. There was heterogeneity between the studies, which were of limited quality and size. Consequently, no single non-operative treatment regimen for fracture of the neck of the fifth metacarpal can be recommended as superior to another. Further research is definitely warranted.

Read the full abstract...

Subcapital fractures of the fifth metacarpal bone, meaning fractures just below the knuckle of the little finger, account for approximately 20% of all hand fractures. Currently, there is no consensus concerning the optimal management of these fractures. Traditionally, treatment consists of closed reduction and external splinting in a neutral position using plaster of Paris (POP), involving the metacarpal joint, the proximal interphalangeal joint and the carpo-metacarpal joint. An alternative treatment strategy is functional treatment using taping or bracing that does not restrict movement.


To compare functional treatment with immobilization, and to compare different periods and types of immobilization, for the treatment of closed fifth metacarpal neck fractures in adults.

Search strategy: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (June 2008), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2008, Issue 3), OVID OldMEDLINE (1951 to 1965), OVID MEDLINE (1966 to May Week 3 2008), EMBASE (1988 to 2008, Week 22), and reference lists of articles. No language restrictions were applied.

Selection criteria: 

All randomized and quasi-randomized controlled trials which compare functional treatment with immobilization or different types of immobilization for closed fifth metacarpal neck fractures.

Data collection and analysis: 

Two review authors assessed abstracts of all studies identified by the initial search, identified studies meeting the selection criteria, independently assessed the quality of the trial reports, and extracted and analysed the data.

Main results: 

Five studies met the inclusion criteria including a total of 252 participants. Most studies were of poor quality. The primary outcome measure, function of the hand, was not used in any studies. There was no evidence that any of the treatment modalities was statistically significantly superior.