Is High Volar Angulation in Fifth Metacarpal Neck Fractures Functionally Tolerable? A Retrospective Series of Conservative Treatment Outcomes

Aim: This study aimed to evaluate the clinical and functional outcomes in cases with a volar angulation of 45° or more who were treated conservatively for fifth metacarpal neck fractures.Material and Methods: The study included 49 male patients diagnosed with a fifth metacarpal neck fracture and treated conservatively with a volar angulation greater than 45° between September 2021 and September 2024. All patients were treated with an ulnar gutter splint. At the final follow-up, assessments included the Visual Analog Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH), Functional Scoring System (FSS), range of motion (ROM) of the metacarpophalangeal (MP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints, and grip strength.Results: The average age of the patients was 33.75 ± 9.50 years, with a mean follow-up duration of 19.93 ± 4.31 months. The most common injury mechanism was punching (69.4%), and the right hand was affected in 85.7% of cases. The mean VAS score was 0.12 ± 0.48, the mean Q-DASH score was 1.48 ± 2.52, and the mean FSS score was 29.53 ± 0.98. The average ROM measured was MP: 91.3 ± 3.8°, PIP: 107.6 ± 5.9°, and DIP: 84.6 ± 5.6°. The mean grip strength was 44.18 ± 7.64 kg.Conclusion: This study demonstrates that for fifth metacarpal neck fractures with an angulation of 45° or more, conservative treatment can achieve good functional outcomes and maintain ROM.