From the Guidelines
The best immobilization for a first metacarpal fracture is typically achieved with a thumb spica cast or splint, as it effectively immobilizes the fracture site while maintaining the thumb's functional position. This approach is supported by the general principles of fracture management, which emphasize the importance of immobilization in promoting proper healing 1. When considering the specifics of first metacarpal fractures, it's crucial to differentiate between stable, non-displaced fractures and those that are displaced or unstable.
- For stable, non-displaced fractures, a removable thumb spica splint may be sufficient, allowing for some degree of mobility while still providing the necessary support.
- Displaced or unstable fractures, on the other hand, generally require a more rigid form of immobilization, such as a well-molded thumb spica cast, to ensure proper alignment and healing. The immobilization should extend from the distal tip of the thumb to the mid-forearm, with the thumb maintained in a position of function and slight opposition, the wrist in slight extension (about 20-30 degrees), and the metacarpophalangeal joint in slight flexion (10-15 degrees) 1. Immobilization typically lasts 4-6 weeks, with radiographic follow-up at 1-2 weeks to ensure the fracture remains properly aligned.
- Key considerations include:
- The position of immobilization to maintain functional capability of the thumb.
- The duration of immobilization, which should be long enough to allow for fracture healing but not so long as to cause significant stiffness or loss of function.
- The need for radiographic follow-up to monitor the healing process and make any necessary adjustments to the treatment plan. In cases where fractures are severely displaced, unstable, or intra-articular, surgical fixation may be necessary before immobilization to ensure the best possible outcome in terms of morbidity, mortality, and quality of life 1.
From the Research
Immobilization Options for First Metacarpal Fracture
- The primary goals for treating metacarpal fractures, including those of the first metacarpal, are to achieve anatomic and stable reduction, bony union, and early mobilization to minimize disability 2.
- For fractures of the base of the first metacarpal, treatment options vary depending on whether the fracture is intra-articular or extra-articular, with surgical treatment recommended for unstable fractures 3.
- Closed reduction and percutaneous Kirschner-wire fixation is generally the appropriate treatment for a Bennett fracture, while Rolando fractures can be treated with either open reduction and internal fixation or external fixation 3.
- A modified thumb spica cast (MTSC) has been shown to be a reliable form of immobilization for treating injuries of the metacarpophalangeal joint of the thumb, including metacarpal fractures, allowing for improved functional capabilities during immobilization 4.
- Removable orthoses are recommended for immobilization of nonsurgical metacarpal fractures, offering effectiveness in healing, patient satisfaction, and time to return to activity 5.
Specific Considerations
- The choice of immobilization method may depend on the specific type and location of the fracture, as well as the patient's overall condition and activity level 3, 5.
- Immobilization recommendations may vary depending on the age and population of the patient, with removable orthoses being considered an equal or superior treatment method to cast immobilization for many common upper-extremity injuries 5.