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Gamble D, Jenkins PJ, Edge MJ, et al. Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures. Hand (N Y). 2015;10(4):607-12doi: 10.1007/s11552-015-9749-8.
Gamble, D., Jenkins, P. J., Edge, M. J., Gilmour, A., Anthony, I. C., Nugent, M., & Rymaszewski, L. A. (2015). Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures. Hand (New York, N.Y.), 10(4), 607-12. https://doi.org/10.1007/s11552-015-9749-8
Gamble, David, et al. "Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures." Hand (New York, N.Y.) vol. 10,4 (2015): 607-12. doi: https://doi.org/10.1007/s11552-015-9749-8
Gamble D, Jenkins PJ, Edge MJ, Gilmour A, Anthony IC, Nugent M, Rymaszewski LA. Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures. Hand (N Y). 2015 Dec;10(4):607-12. doi: 10.1007/s11552-015-9749-8. Epub 2015 Feb 18. PMID: 26568712; PMCID: PMC4641074.
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Hand (N Y). 2015 Dec;10(4):607-12. doi: 10.1007/s11552-015-9749-8. Epub 2015 Feb 18.

Satisfaction and functional outcome with "self-care" for the management of fifth metacarpal fractures.

Hand (New York, N.Y.)

David Gamble, Paul J Jenkins, Martyn J Edge, Alisdair Gilmour, Iain C Anthony, Margaret Nugent, Lech A Rymaszewski

Affiliations

  1. Department of Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 OSF UK.

PMID: 26568712 PMCID: PMC4641074 DOI: 10.1007/s11552-015-9749-8

Abstract

BACKGROUND: Fifth metacarpal fractures are common and comprise a significant proportion of traditional orthopaedic fracture clinic workload. We reviewed the functional outcome and the satisfaction of patients managed with a new protocol that promoted "self-care" and resulted in the discharge of most of these patients from the emergency department with no further follow-up.

METHODS: A retrospective study was performed of patients discharged with a fifth metacarpal fracture between April 2012 to October 2012. A postal questionnaire was sent to each patient, followed by a telephone call. Patient-reported outcome measures (EQ-5D, QuickDASH) and patient satisfaction were assessed. Of the 167 patients eligible for the study, 5 were excluded. Of the remaining 162, 64 were uncontactable or declined to participate. The mean follow-up time was 21.6 months (SD 1.9, range 18.1 to 24.7).

RESULTS: The median EQ-5D health index score was 0.87 (IQR 0.74 to 1.00), and the median QuickDASH score was 2.3 (IQR 0 to 6.8). Seventy-nine (80.6 %) patients were satisfied with the outcome of their injury, while 83 (84.9 %) reported being satisfied with the process. There was no difference between those with a fracture or those without a fracture in EQ-5D (p = 0.307) or QuickDASH (p = 0.820).

CONCLUSION: Fifth metacarpal fractures can be managed effectively through an Emergency Department protocol without any formal orthopaedic follow-up. This pathway lead to excellent patient-reported outcome measures and patient satisfaction. This protocol has reduced unnecessary hospital attendances for patients and increased the time available for clinicians to deal with more challenging injuries.

Keywords: Fracture; Fracture clinic redesign; Metacarpal; Virtual fracture clinic

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