INTRODUCTION: 

• Metacarpal fractures are among the most common orthopaedic injuries.^1,2 
• Frequently treated with closed reduction and percutaneous pinning (CRPP).^1,2 
• Risk factors for treatment failure and need for reintervention after CRPP remain unclear. ¹

 

METHODS 

• The TriNetX database was queried for patients with metacarpal fractures treated with CRPP. 
• Patient demographics, psychosocial history, and fracture characteristics were assessed for association with treatment failure, defined as any reintervention within 6 months of injury.
• Associations identified on univariate were further analyzed after 1:1 propensity score-matching (PSM) using logistic regression.

 

RESULTS/DISCUSSION

• Among 15,154 patients, 5.1% required reintervention 
• Risk factors: male sex, white race, mood disorders, nicotine/cannabis use, second/third metacarpal and shaft fractures
• Protective factors: age ≤30, female sex, and 5th metacarpal fractures
• Age ≥65 was not linked to increased reintervention risk whereas those ≤30 years had a reduced risk.
• Fracture characteristics were the strongest predictors of revision to ORIF.
• Shaft and 2nd/3rd metacarpal fractures had higher reintervention risk; 5th metacarpal fractures were associated with lower risk
• Affective mood disorders increased reintervention risk, unlike other psychiatric conditions, highlighting the need for improved preoperative counseling and mental health support.
• Nicotine and cannabis use raised risk; alcohol did not, indicating substance-specific effects on healing and outcomes.³

 

CONCLUSION 

• Reintervention risk after CRPP is multifactorial.
• Identifying key demographic, psychosocial, and injury-specific risk factors can guide surgical decision-making and enhance patient counseling, leading to better outcomes in metacarpal fracture management.

 

REFERENCES 

1. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal Fractures: Treatment and Complications. HAND. 2014;9(1):16-23. doi:10.1007/s11552-013-9562-1

2. Nakashian MN, Pointer L, Owens BD, Wolf JM. Incidence of Metacarpal Fractures in the US Population. HAND. 2012;7(4):426-430. doi:10.1007/s11552-012-9442-0

3. Miltenberg B, Nemirov D, Siddiqui H, Kasper A, Ilyas AM. Metacarpal Fracture Repair: Early Reoperation Rates and Characteristics. J Hand Surg Glob Online. 2024;6(1):27-30. doi:10.1016/j.jhsg.2023.08.003