Return to sport after metacarpal and phalangeal fractures: a systematic review and evidence appraisal

Review written by Dr Ian Gatt info

Key Points

  1. Non-operative and operative management strategies were more commonly reported in metacarpal and phalangeal fractures, respectively.
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Fractures of the metacarpals and phalanges account for up to 39.2% of all sports-related fractures (1,2), and 54.8% of upper limb fractures sustained by competitive athletes (3). A high incidence of injuries is observed in contact, combat and ball-handling sports (4). The mechanism of injury appears to be due to direct blunt trauma and falling onto a clenched fist (5).

The management of metacarpal and phalangeal fractures aims at ensuring minimal disruption to training and competition availability by returning athletes to pre-injury status in the shortest timeframe possible. Both operative and conservative strategies (Figure 1) can be recommended depending on which one achieves the best anatomical stability, whilst still facilitating appropriate return to play in athletes.


Currently, there is a lack of consensus regarding the best management strategies for return to play. This systematic review was therefore aimed at determining which management strategy is best for expediting return to pre-injury levels of competition in adults participating in sports after sustaining closed fractures of the metacarpals and/or phalanges.

Fractures of the metacarpals and phalanges account for up to 39% of all sports-related fractures.
Although the use of timescales is an important factor for return to sport, ensuring the appropriate use of outcome measures provides milestones of progression.


3135 records were identified through database searching. After duplicates were removed, 2105 records were screened, of which 8 met the full inclusion criteria. All randomized controlled trials, clinical trials, cohort studies, comparative studies, case series, and case reports were eligible

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