Effectiveness of Hand Rehabilitation Programs for Non-Thumb Metacarpal Fractures: A Systematic Review and Meta-Analysis.

Background: Non-thumb metacarpal fractures (II-V) are prevalent hand injuries that can severely compromise hand function, grip strength, and range of motion (ROM) if not appropriately rehabilitated. Various rehabilitation strategies - ranging from physiotherapy and home-based exercises to early mobilization and gamification - have been introduced, but their relative effectiveness remains unclear. Objectives: This meta-analysis aimed to evaluate and compare the effectiveness of different rehabilitation programs for non-thumb metacarpal fractures, focusing on improvements in hand function, grip strength, and ROM. Methods: A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus from inception to January 2025. Randomized controlled trials (RCTs) and cohort studies evaluating rehabilitation for non-thumb metacarpal fractures were included. Interven-tions studied included conventional physiotherapy, home-based exercise, gamification, early mobilization, and immobilization techniques (e.g., buddy taping vs. plaster). Data extraction and bias assessments were performed independently by two reviewers. Meta-analyses were conducted using Review Manager 5.4. This study was preregistered with PROSPERO (CRD42024619888). Results: Five studies (three RCTs, two cohort studies) met the inclusion criteria. Rehabilitation significantly improved hand function (SMD = -1.04, 95% CI: -1.54 to -0.54), grip strength (MD = 21.33, 95% CI: 18.81 to 23.83), and ROM (MD = 23.43, 95% CI: 20.15 to 26.72). Early mobilization and gamification strategies were associated with enhanced functional outcomes and patient adherence. Conclusions: Structured rehabilitation programs, especially those incorporating early mobilization and digital adherence strategies, are effective in improving outcomes for non-thumb metacarpal fractures. Minimal immobilization approaches such as buddy taping may be suitable for stable fractures.