Sletten et al. randomized 85 patients with small finger metacarpal neck fractures angulated >30° into surgical and nonsurgical treatment groups. The surgical group was treated with antegrade intramedullary pinning (aka bouquet pinning).1 No attempt of closed reduction was made for the patients with metacarpal fractures randomized to the nonsurgical treatment group. Both groups were treated in a plaster splint for one week, followed by a functional brace for three weeks. There was no statistically significant difference between the two groups at one‐week, six‐week, three‐month, or one‐year follow‐up with regard to QuickDASH scores, grip strength, total active ROM, or patient satisfaction Visual Analog Score (VAS). At three months, 46.5% (20 of 43) patients in the nonsurgical group reported that they were discontent with their hand function compared to 31% (13 of 42) of those who underwent surgical treatment, but these differences resolved at the one‐year follow‐up. However, at one year, 17.5% (7 of 40) conservatively treated patients reported that they were not content with their hand appearance, compared to 1 of 36 operatively treated patients (2.8%). Patients in the operative group experienced more complications (19 compared to 10) including complex regional pain syndrome, superficial infection, pin migration, and bent pins.

Strub et al. prospectively followed 40 patients for 12 months undergoing either antegrade intramedullary (aka bouquet) pinning or functional bracing without reduction for small finger metacarpal neck fractures angulated 30–70°.² There was no difference between the two groups in MP joint ROM at two weeks, six weeks, three months, six months, or one year. Grip strength was only measured at one year after injury and was equal between the two groups. All of the operative patients underwent pin removal at three months. Complications in the operative group included delayed wound healing after pin removal (one patient), secondary displacement (one patient), and dissatisfaction with scarring (three patients). In the nonsurgical group, 55% (11 of 20) patients reported dissatisfaction with the aesthetic appearance of the knuckle, and four patients complained of feeling the metacarpal head in their palm with heavy grip. Overall patient satisfaction was equivalent in the two groups. Compared to the study by Sletten et al, the Strub et al. study had a smaller sample size and no patient‐reported outcome measures. In addition, the authors did not report how they ascertained the patient’s opinion of the appearance of their hand, which was one of the few differences between the two groups.