Does Age Affect Healing Time in Metacarpal Fractures?

Purpose: Older patients are becoming a larger part of hand surgery and are consequently being treated by the surgeon with increasing frequency. The surgeon needs to decide on surgical versus conservative treatment for fractures in an elderly patient, and on postoperative immobilization time and therapy. Studies in animals suggest that older mice and rats heal fractures more slowly. The clinical implications, however, are not clear. A better understanding of differences in healing related to age can help customize fracture treatment. Our purpose was to retrospectively evaluate metacarpal fractures for healing time looking specifically at age related differences.

Methods: Retrospective review of patients treated for metacarpal fractures. Patients with incomplete charts or inadequate follow-up were excluded. Two-hundred charts were analyzed. Demographic information and other patient factors (background disease, smoking status, hand dominance, occupation) were documented. Fracture characteristics and treatment type were documented. Outcome variable was time to healing. Fracture healing was determined clinically. Plain radiographs and examination were used in decision-making.

Results: Age was not associated with fracture healing time as a continuous variable (p=0.09). Patients above 75 years were considered separately and no association to healing was found (p=0.58). Fracture characteristics, were related to healing time: minimally displaced and comminuted fractures healed faster than oblique fractures, spiral fractures or transverse fractures (p = 0.048). Patients undergoing surgery healed faster than those without surgery (p = .046). Renal failure was negatively associated with fracture healing p=0.03. Diabetes, hypothyroidism and gender were not associated with healing time. Complications were not associated with age or other patient or fracture related factors.

Conclusions: 1) Age does not affect clinical fracture healing time in the adult. Therefore, older patients do not need disparate treatment.

2) Other fracture related factors and considerations such as functional demand and support systems might influence treatment decisions in fracture care.