From the Guidelines
The treatment for a second digit hand metacarpal fracture typically involves simple immobilization when fracture fragments are small, nonarticular, or minimally displaced. This approach is based on the principle that minimal intervention is required for fractures with minimal displacement or fragmentation, as stated in a study published in the American Family Physician 1. The goal of treatment is to promote proper healing, maintain alignment, and restore hand function.
When considering treatment options, the following factors are important:
- Fracture stability and displacement: Stable, non-displaced fractures can be managed conservatively, while displaced fractures may require surgical intervention.
- Fragment size and articular involvement: Small, nonarticular fragments may be treated with immobilization, while larger fragments or those involving the joint may require more aggressive treatment.
- Patient factors: Age, activity level, and overall health can influence treatment decisions.
In general, treatment for a second digit hand metacarpal fracture may involve:
- Immobilization with a hand-based splint or cast for 4-6 weeks
- Conservative management with rest, ice, elevation, and pain medications for stable, non-displaced fractures
- Surgical intervention, including closed reduction with percutaneous pinning or open reduction with internal fixation, for displaced fractures with significant angulation or rotation
- Physical therapy to restore hand function and strength after immobilization
Regular follow-up with hand x-rays at 2-3 week intervals is recommended to ensure proper healing and alignment, as the metacarpal bone plays a critical role in hand function and grip strength. By prioritizing immobilization and proper alignment, patients can achieve optimal outcomes and minimize the risk of long-term morbidity and mortality.
From the Research
Treatment Options for Second Digit Hand Metacarpal Fracture
- The majority of metacarpal fractures, including those of the second digit, are managed non-operatively 2, 3.
- When surgical intervention is indicated, various methods of fixation are available, including open reduction and internal fixation, closed reduction percutaneous pinning, external fixation, and intramedullary screw fixation 2, 4.
- Early mobilization is a critical component of treatment to prevent stiffness and restore function, especially in cases of open reduction and internal fixation 2, 3.
- The choice of fixation method depends on the injury pattern, patient function, and surgeon preference 2.
Rehabilitation Programs
- Hand rehabilitation programs are essential for the management of second to fifth metacarpal fractures, including those of the second digit 5.
- A well-designed, well-implemented home-based exercise program can result in statistically significant improved hand function and digital total active motion compared to traditional physiotherapy 5, 6.
- Both home exercise programs and traditional physical therapy are effective in the postoperative management of metacarpal fractures 6.
Postoperative Management
- Postoperative treatment of metacarpal fractures, including those of the second digit, can involve either a home exercise program or traditional physical therapy 6.
- Early range of motion and grip strength exercises are crucial for optimal recovery and functional outcomes 3, 6.
- Intramedullary screw fixation is a relatively new surgical technique that allows patients to resume range of motion early in the postoperative period with excellent clinical outcomes 4.