From the Guidelines
A splint for a 5th metacarpal fracture should be used to immobilize the wrist and metacarpophalangeal joints, promoting proper healing and preventing stiffness and contractures, as recommended by the most recent evidence 1. The use of a splint for a 5th metacarpal fracture is a common practice, and the most recent evidence suggests that it can be beneficial in reducing pain and preventing further injury 1. The splint should be applied in a way that immobilizes the wrist in slight extension (20-30 degrees) and the metacarpophalangeal joints at 70-90 degrees of flexion, with the interphalangeal joints in slight flexion. This position, known as the "safe position," helps prevent stiffness and contractures while promoting proper healing.
Some key points to consider when using a splint for a 5th metacarpal fracture include:
- Immobilization usually lasts 3-4 weeks for non-displaced fractures, with follow-up radiographs at 1-2 weeks to ensure proper alignment 1.
- Patients should elevate the hand above heart level to reduce swelling, apply ice for 15-20 minutes several times daily for the first 48-72 hours, and take appropriate pain medication as prescribed 1.
- Active range of motion exercises for uninvolved digits should be encouraged to prevent stiffness.
- The splint should extend from mid-forearm to the fingertips, covering the ulnar (pinky) side of the hand and including the 4th and 5th digits.
It's worth noting that while splinting can be beneficial, it's not without potential risks, such as increasing attention and focus to the area, thereby exacerbating symptoms, or leading to muscle deconditioning and learnt non-use 1. However, the most recent evidence suggests that the benefits of splinting outweigh the risks, and it should be considered as part of the treatment plan for a 5th metacarpal fracture 1.
From the Research
Treatment Options for 5th Metacarpal Fracture
- Functional metacarpal splint (FMS) and ulnar gutter splint (UGS) are two common conservative treatment methods for 5th metacarpal neck fractures 2
- FMS is adequate to prevent loss of reduction and yields faster improvement in clinical scores with earlier gain of normal grip strength compared to UGS 2
- UGS is a simple and proven method for immobilizing boxer's fractures, which are isolated fractures of the distal fourth or fifth metacarpal bones 3
- Conservative management is the preferred option for closed, non-angulated, non-malrotated fractures, while open fractures, significant angulation, rotational deformity, and intra-articular extension are recognized indications for surgical intervention 4
Comparison of Treatment Methods
- A study comparing FMS and UGS found that both methods yield similar radiological and clinical outcomes in the long term, but FMS may provide faster improvement in clinical scores and earlier gain of normal grip strength 2
- Another study found that buddy taping is as effective as plaster immobilization for adults with uncomplicated neck of fifth metacarpal fracture, with similar functional outcomes at 12 weeks 5