Is anatomical reduction of fractures of the fourth and fifth metacarpals useful?

Most fractures of the fourth and fifth metacarpals are treated conservatively. How necessary it is to pursue anatomical reduction of these fractures has not been determined. In order to evaluate whether anatomical reduction will result in a better outcome, two groups of one hundred patients each, were compared. One group had been treated with near-anatomical reduction. Only partial reduction had been accomplished in a control group with similar fractures. The residual radiographic angulation of the subcapital fracture at the four-week follow-up was measured in both groups, but no significant difference could be demonstrated. In shaft fractures, however, the anatomical reduction group showed significantly less residual angulation. Only reduction of shaft fractures is worthwhile in order to achieve a better anatomical outcome.