From the Guidelines
The treatment for a mildly displaced fracture of the metacarpophalangeal (MCP) joint at the base of the thumb typically involves simple immobilization, as this approach is appropriate for minimally displaced fractures. According to the American College of Foot and Ankle Surgeons, as reported in the American Family Physician 1, simple immobilization is suitable when fracture fragments are small, nonarticular, or minimally displaced.
Key Considerations
- Immobilization should be maintained for a period of 4-6 weeks to allow proper healing.
- The immobilization method, such as a thumb spica cast or splint, should position the thumb in slight flexion and abduction to maintain proper alignment.
- Pain management can be achieved with over-the-counter medications like acetaminophen or NSAIDs, if not contraindicated.
- Regular application of ice for 15-20 minutes several times daily during the first few days will help reduce swelling.
Post-Immobilization Care
- After the immobilization period, gentle range-of-motion exercises should be initiated under the guidance of a hand therapist.
- Gradually progressing to strengthening exercises is crucial for restoring full function to the thumb and hand.
- It is essential to monitor the fracture's healing progress and the patient's overall recovery to determine the best course of action and to address any potential complications early on.
Surgical Intervention
- For more significantly displaced fractures, surgical intervention may be necessary to restore proper alignment and joint function.
- The decision to proceed with surgery should be based on the degree of displacement and the potential impact on the patient's quality of life and functional outcomes.
From the Research
Treatment Options for Thumb Base MCP Fracture Displaced Mild
- The treatment for a displaced mild thumb base MCP fracture depends on the type and severity of the fracture, as well as the patient's overall health and activity level 2, 3.
- For extra-articular fractures, closed reduction and casting may be sufficient, while displaced intra-articular fractures may require surgical intervention 2.
- Bennett fractures, which are a type of intra-articular fracture, can often be treated with closed reduction and percutaneous pinning or open reduction and internal fixation 2, 3.
- The goal of treatment is to achieve anatomical reduction of the joint surface to minimize the risk of post-traumatic arthritis and optimize functional outcomes 2, 3.
Non-Surgical Treatment
- Closed reduction and casting can be effective for stable extra-articular fractures, with angulation up to 30 degrees being tolerable due to the substantial compensatory motion at the thumb carpometacarpal joint 3.
- A modified thumb spica cast (MTSC) can be used to immobilize the thumb and allow for full flexion and extension of the wrist, with good functional results and no residual discomfort or loss of position 4.
Surgical Treatment
- Open reduction and internal fixation may be necessary for fractures with large Bennett fragments or Rolando fractures to allow for anatomic reduction and rigid fixation 2, 3.
- Comminuted intra-articular fractures can be challenging to treat and may require the application of an external fixator with limited open reduction and internal fixation, followed by bone grafting of metaphyseal bone defects if necessary 3.