What is the management of a thumb fracture with a small superficial laceration?

From the Guidelines

Management of a thumb fracture with a small superficial laceration should prioritize thorough wound cleaning with sterile saline or running tap water, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. When managing a thumb fracture with a small superficial laceration, it is essential to address both the fracture and the wound.

• Clean the laceration thoroughly with sterile saline or running tap water, as antiseptic agents such as povidone-iodine are not recommended for wound irrigation 1.
• Assess the wound for foreign bodies or tendon involvement.
• Apply antibiotic ointment (such as bacitracin or mupirocin) and cover with an occlusive dressing to promote wound healing, as suggested by the guidelines 1.
• For the fracture, immobilization is essential using a thumb spica splint or cast depending on fracture severity and location.
• Non-displaced fractures typically require 4-6 weeks of immobilization, while displaced fractures may need surgical reduction and fixation, as simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1.
• Pain management should include acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) as needed.
• Elevate the hand above heart level to reduce swelling, and apply ice for 15-20 minutes several times daily for the first 48-72 hours.
• Follow-up with orthopedics within 7-10 days is recommended for repeat imaging to ensure proper alignment.
• The laceration should be monitored for signs of infection (increasing redness, warmth, pain, or purulent drainage), and antibiotics such as cephalexin 500mg four times daily for 5-7 days may be prescribed if infection risk is high due to contamination or delayed presentation.

From the Research

Management of Thumb Fracture with Small Superficial Laceration

• The management of thumb fractures with small superficial lacerations can be approached through various methods, including splint immobilization and surgical intervention, depending on the type and severity of the fracture 2, 3, 4.
• For extra-articular fractures, closed reduction and cast immobilization may be sufficient, with angulation up to 30 degrees being tolerable due to the substantial compensatory motion at the thumb carpometacarpal joint 3, 4.
• Intra-articular fractures, such as Bennett and Rolando fractures, often require surgical intervention to achieve anatomic reduction and prevent long-term complications like posttraumatic arthritis 3, 4.
• The use of a modified thumb spica splint can be an effective treatment modality for thumb injuries, including fractures, in the emergency department setting 5.
• Immediate postoperative motion of the operated joint can produce faster and better functional results, as seen in the management of skier's thumb lesions 6.

Treatment Options

• Closed reduction and casting for stable extra-articular fractures
• Surgical intervention, including percutaneous pinning or open reduction and internal fixation, for displaced intra-articular fractures
• Use of a modified thumb spica splint for immobilization and support
• Early range of motion and physiotherapy to enhance functional recovery and reduce the risk of stiffness and complications 6, 2, 3, 4.