The CARBO CARBON Study

This study examines the environmental impact of two common treatment pathways for hand fractures (metacarpal shaft fractures): surgical and non-surgical management. Healthcare contributes significantly to climate change, and orthopedic surgery in particular generates substantial greenhouse gas emissions. Although surgical treatment is frequently favored for these fractures, it is not always superior to non-surgical treatment, and the difference in environmental impact between these options is not well understood. In this study, researchers will measure and compare the environmental impact of each treatment pathway, from inclusion to twelve months follow-up. This includes environmental impact related to single-use material, medical equipment, energy use, medications, and waste. A Life Cycle Assessment (LCA) will be performed and a mean difference in environmental impact between treatments pathways will be calculates. A Hotspot analysis will also be performed to highlight key sources of environmental impacts. The findings may help guide more sustainable healthcare practices without compromising patient care.

Inclusion Criteria for the CARBO trial: Age ≥18 years. Access to a valid e-mail. Injury within 10 days prior to inclusion. Normal bilateral hand function prior to injury. Ability and willingness to provide written informed consent Single, displaced spiral or oblique diaphyseal fracture of the second to fifth metacarpals with definition of diaphysis as described by AO 2018 (AO/OTA as 77.2-5.2A) (Meinberg et al., 2018). Fracture line length at least twice the diameter of the bone at the level of the fracture. Fractures with at least 2 mm of radiological displacement and/or malrotation of injured finger compared to uninjured side regardless of fracture displacement. Exclusion Criteria: The patient is not expected to have difficulty adhering to the study protocol (e.g., due to insufficient language proficiency, dementia, substance abuse, or other reasons). The patient does not have an open fracture (Gustilo-Anderson grade \> I) or a pathological fracture. The patient does not have an ipsilateral fracture of the upper extremity, polytrauma, or generalized joint dysfunction (e.g., rheumatoid arthritis).