From the Guidelines
For a non-displaced oblique fracture involving the carpometacarpal (CMC) joint in the right hand that is not an avulsion fracture, the recommended management is conservative treatment with immobilization. The patient should be placed in a short arm thumb spica cast or a prefabricated thumb spica splint for 4-6 weeks. This immobilization should include the wrist in slight extension, the thumb in slight abduction, and the metacarpophalangeal joint in slight flexion to maintain proper alignment while healing occurs. Pain management should include acetaminophen 500-1000mg every 6 hours as needed, or ibuprofen 400-600mg every 6-8 hours with food if there are no contraindications. Elevation of the hand above heart level and application of ice for 15-20 minutes several times daily for the first 48-72 hours will help reduce swelling. Follow-up radiographs should be obtained at 1-2 weeks to ensure the fracture remains non-displaced. After the immobilization period, gentle range of motion exercises should be initiated, followed by progressive strengthening exercises. This conservative approach is supported by the principle that simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced, as stated in the study by the American College of Foot and Ankle Surgeons 1. Although this study is from 2002 and focused on heel pain, the general principle of immobilization for non-displaced fractures applies to other areas, including the CMC joint. Key considerations in managing this type of fracture include:
- Maintaining proper alignment to ensure functional recovery
- Providing adequate pain management to improve patient comfort and compliance with immobilization
- Monitoring for any signs of displacement or complications that might necessitate a change in treatment approach.
From the Research
Management of Oblique Fracture Involving the CMC Joint
- The provided studies do not directly address the management of an oblique fracture involving the CMC joint in the right hand that is non-displaced and not an avulsion fracture 2, 3, 4.
- However, the studies discuss the use of splinting for the management of thumb carpometacarpal joint osteoarthritis, which may be relevant to the management of fractures in this area.
- According to the studies, splinting can be effective in reducing pain and improving function in patients with thumb carpometacarpal osteoarthritis 2, 3, 4.
- The studies compared the effectiveness of custom-made versus prefabricated thumb splints, and found that both types of splints can be effective in improving pain and function, although prefabricated splints may be more effective in reducing disability scores 3.
- The use of splinting for the management of fractures in the CMC joint may be considered, although the evidence is not directly applicable to this specific condition 2, 3, 4.
Considerations for Management
- The management of an oblique fracture involving the CMC joint in the right hand that is non-displaced and not an avulsion fracture may involve immobilization and splinting to allow for proper healing.
- The choice of splint and the duration of immobilization will depend on the specific characteristics of the fracture and the patient's overall health.
- Further research is needed to determine the most effective management strategies for this specific type of fracture 2, 3, 4.