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

BackgroundFractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes.PurposeTo determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures.Study designSystematic review; Level of evidence, 4.MethodsA 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.ResultsOverall, 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.ConclusionOptimal 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.