From the Guidelines
The treatment for a non-displaced proximal metacarpophalangeal (MCP) fracture of the thumb typically involves conservative management with immobilization. This approach is supported by the principle that simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced, as noted in a study published in the American Family Physician 1. The primary goal is to maintain the thumb in a functional position while allowing the fracture to heal. Key aspects of conservative management include:
- Immobilization with a thumb spica splint or cast for 3-4 weeks
- Use of a removable splint for an additional 2-3 weeks during activities
- Gentle range of motion exercises after the initial immobilization period
- Pain management with acetaminophen or NSAIDs like ibuprofen for the first 1-2 weeks
- Ice application and elevation of the hand to reduce swelling Regular follow-up with x-rays at 2-3 weeks is crucial to ensure the fracture remains properly aligned during healing, which is a critical factor in preventing complications and promoting optimal recovery, as implied by the importance of radiographic confirmation in diagnosis 1. By prioritizing conservative management and closely monitoring the healing process, most non-displaced thumb MCP fractures can heal well without the need for surgical intervention.
From the Research
Treatment Options for Thumb Proximal MCP Fracture Non-Displaced
- For non-displaced fractures of the thumb proximal metacarpal, treatment options are focused on maintaining alignment and promoting healing while minimizing stiffness and promoting early motion.
- According to 2, most extra-articular fractures can be treated with closed reduction and cast immobilization, with angulation up to 30 degrees being tolerable due to the substantial compensatory motion at the thumb carpometacarpal joint.
Specific Considerations for Intra-Articular Fractures
- For intra-articular fractures, such as Bennett fractures, the goal of treatment is anatomic reduction of the joint surface with less than 1 mm of articular step-off to minimize the long-term risk of posttraumatic arthritis 2.
- Closed reduction with percutaneous Kirschner wire fixation may be suitable for most Bennett fractures, while fractures with large Bennett fragments and Rolando fractures may require open reduction and internal fixation 2.
Postoperative Management
- While the provided studies do not directly address the treatment of non-displaced thumb proximal MCP fractures, 3 discusses the importance of early postoperative motion in the management of skier's thumb lesions, suggesting that similar principles may apply to other thumb injuries.
- The use of a functional splint that allows immediate postoperative motion may be beneficial in enhancing patient function and reducing the time of functional recovery 3.