Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal

Luke Geoghegan; Alexander Scarborough; Jeremy N Rodrigues; Mike J Hayton; Maxim D Horwitz

doi:10.1177/2325967120980013

Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal

Orthop J Sports Med. 2021 Feb 23;9(2):2325967120980013. doi: 10.1177/2325967120980013. eCollection 2021 Feb.

Authors

Luke Geoghegan¹, Alexander Scarborough², Jeremy N Rodrigues³, Mike J Hayton⁴, Maxim D Horwitz^{5

6}

Affiliations

¹ Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
² Kings College NHS Foundation Trust, London, UK.
³ Department of Plastic Surgery, Stoke Mandeville Hospital, Aylesbury, UK.
⁴ Department of Trauma, Orthopaedic and Hand Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK.
⁵ Hand Management Unit, Chelsea and Westminster Hospital, London, UK.
⁶ Department of Surgery and Cancer, Imperial College London, London, UK.

Abstract

Background: Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes.

Purpose: To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures.

Study design: Systematic review; Level of evidence, 4.

Methods: A methodology compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used. A custom search strategy was designed and applied to MEDLINE and In-Process, Embase, EMCARE, and CINAHL.

Results: Overall, 3135 records were identified, of which 8 met full inclusion criteria. All patients returned to preinjury levels of competition, at a mean of 30.6 days for phalangeal fractures and 21.9 days for metacarpal fractures. Meta-analysis demonstrated delayed return-to-sport time for operatively managed metacarpal fractures as compared with nonoperatively managed ones (28.5 vs 22.0 days). All studies were of fair or poor quality, and none were randomized.

Conclusion: Optimal management strategies for athletes with metacarpal and phalangeal fractures remain equivocal. Injury, treatment, and sport-specific factors may confound results and preclude accurate estimation of optimal treatment strategies at present.

Keywords: athletic performance; fractures; hand; metacarpus; return to sport.

Publication types

Review