{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T22:11:09Z","timestamp":1782771069415,"version":"3.54.5"},"reference-count":51,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,11,1]],"date-time":"2020-11-01T00:00:00Z","timestamp":1604188800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Hand Surg Eur Vol"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Cadaveric studies suggest that the acceptable deformity in fifth metacarpal neck fractures is maximally 30\u00b0 palmar angulation. This systematic review verifies the validity of these threshold values. Eighteen prospective comparative studies on operative and\/or conservative treatment options in adults were included. None of the studies demonstrated any correlation between the residual or initial angulation and the clinical results despite accepting more severe angular deformities. Closed reduction and immobilization without internal fixation improved the palmar angle by 5\u00b0 to 9\u00b0 in three studies and 29\u00b0 in a fourth. Operative treatments compared with non-reducing conservative treatments showed no benefit of the surgery other than aesthetic issues. The synthesis of this review indicates that 90% of fractures of the metacarpal neck with apex angulation up to 70\u00b0 can be treated successfully with a functional metacarpal brace without reduction. Disability of the Arm, Shoulder and Hand questionnaire scores &lt;10 are uniformly reported. I modified my own practice accordingly a decade ago to treating these fractures conservatively regardless of the palmar angulation, except in patients with exceptional demands or other fracture deformities.<\/jats:p>","DOI":"10.1177\/1753193420968040","type":"journal-article","created":{"date-parts":[[2020,11,2]],"date-time":"2020-11-02T01:20:12Z","timestamp":1604280012000},"page":"30-36","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":25,"title":["Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically"],"prefix":"10.1177","volume":"46","author":[{"given":"Michel E. 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