Bekir KARAGÖZ, Hünkar Çağdaş BAYRAK
Cyprus Journal of Medical Sciences - 2026;11(3):188-196
BACKGROUND/AIMS: To evaluate the radiological and functional effectiveness of repeated closed reduction in patients who developed early loss of reduction at the 48-hour follow-up after an initially successful closed reduction for fifth metacarpal neck fractures, and to examine its association with surgical treatment decisions. MATERIALS AND METHODS: This retrospective matched cohort study included 200 adult patients with isolated, closed fifth metacarpal neck fractures who underwent closed reduction at a tertiary orthopedic center between January 2023 and December 2024. Patients were divided into two equal groups: the (single reduction group, n=100) and the [re-reduction group (RRG), n=100], based on whether they underwent a second closed reduction due to early loss of initially acceptable radiographic alignment detected at the 48-hour follow-up. Matching was performed 1:1 on the basis of age and sex. Radiological parameters-including dorsal angulation and metacarpal shortening-were measured at six time points during follow-up. Functional outcomes were assessed using Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores, grip strength, and joint range of motion. Surgical conversion rates were analyzed, and multivariate logistic regression was used to identify independent predictors of surgical intervention. RESULTS: Initial angulation and shortening were comparable between the groups. However, the RRG exhibited significantly greater deformity at the 4th and 6th weeks, with higher angulation (p=0.007 and p<0.001, respectively) and more pronounced shortening (p=0.001 and p=0.009, respectively). At 6 weeks, QuickDASH scores were significantly worse in the RRG (p=0.002), though this difference was no longer statistically significant by 6 months. Flexion and extension angles were consistently more restricted in the RRG. Importantly, multivariable firth-penalized logistic regression identified initial shortening as the only independent predictor of surgical intervention, while angulation parameters did not retain statistical significance after adjustment. CONCLUSION: Repeated closed reductions for early loss of alignment do not consistently improve outcomes and may be associated with delayed union. Longitudinal evaluation of angulation and shortening provides better clinical guidance than single-time-point assessments; however, among these parameters, initial shortening appears to be the most reliable independent predictor of eventual surgical intervention.
