BACKGROUND: Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes. PURPOSE: To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures. STUDY DESIGN: Systematic review; level of evidence, 4. METHODS: A methodology compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used. A custom search strategy was designed and applied to Medline and In-Process, Embase, EMCARE, and CINAHL. RESULTS: Overall, 3,135 records were identified, of which 8 met full inclusion criteria. All patients returned to preinjury levels of competition, at a mean of 30.6 days for phalangeal fractures and 21.9 days for metacarpal fractures. Meta-analysis demonstrated delayed return-to-sport time for operatively managed metacarpal fractures as compared with nonoperatively managed ones (28.5 versus 22.0 days). All studies were of fair or poor quality, and none were randomized. CONCLUSION: Optimal management strategies for athletes with metacarpal and phalangeal fractures remain equivocal. Injury, treatment, and sport-specific factors may confound results and preclude accurate estimation of optimal treatment strategies at present.

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