Comparing the Efficacy and Safety of Metacarpal Neck Fracture Treatments: A Systematic Review and Network Meta-Analysis
Bibliographic record
Abstract
Purpose: Metacarpal neck fractures may perform well without operative intervention, but the current literature on this topic is fragmented and guidance on managing these injuries needs further refinement. We conducted a systematic review and network meta-analysis to provide a comprehensive evaluation of the various treatments available for these injuries. Methods: We searched 3 electronic databases and included any study comparing interventions for metacarpal neck fractures. We conducted a Bayesian network meta-analysis for each outcome. Results: We identified a total of 14 studies comparing: antegrade (AIMP) or retrograde (RIMP) intramedullary pinning, buddy strapping, transverse pinning (TP), functional bracing, plating, retrograde cross-pinning, a combination of retrograde cross-pinning and plating, and placement of an orthosis or casting. Although the results were not statistically significant, the effect estimates suggested more favorable pain reduction and functional improvement with AIMP compared with nonsurgical therapies and RIMP in the short term (3 months or less). However, differences between interventions at later follow-up were less extreme; data on short-term pain and function with surgical options outside AIMP and RIMP were unavailable. In addition, compared with both plating and TP, AIMP was associated with significantly higher risks for implant migration and neurological events. There were contrasting findings in union-related outcomes. Plating showed the earliest time to union (not statistically significant) but TP demonstrated the lowest risk for a delayed union. Conclusions: This review demonstrated that although AIMP may be a viable surgical option for early symptomatic relief after a metacarpal neck fracture, it may also be associated with a greater likelihood of certain postoperative complications. Clinicians should consider patient preferences for the time frame of symptomatic relief when selecting the optimal treatment, and patients should weigh the advantages and disadvantages of each available option, especially when considering invasive surgery. Considering the lack of high-quality primary research investigating these interventions, future studies are needed to make more definitive conclusions. Type of study/level of evidence: Therapeutic II.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.017 | 0.005 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".