From the Research
The treatment for this injury primarily focuses on the acute comminuted, impacted, and displaced intra-articular fifth metacarpal base fracture with subluxation of the fifth carpometacarpal (CMC) joint, which typically requires orthopedic consultation and likely surgical intervention due to its intra-articular nature, displacement, and associated joint subluxation. This type of fracture is inherently unstable and inadequate reduction may result in pain, functional disability, and osteoarthritic changes, as noted in a study on the surgical treatment of fractures of the base of the fifth metacarpal bone 1. Initial management should include:
- Immobilization with a well-padded ulnar gutter splint
- Elevation of the hand above heart level
- Ice application for 20 minutes every 2-3 hours
- Appropriate pain management with acetaminophen 650mg every 6 hours and/or ibuprofen 600mg every 6 hours if not contraindicated The possible fourth metacarpal base fracture should be included in the treatment plan. Surgery often involves open reduction and internal fixation (ORIF) with pins, screws, or plates to restore joint congruity and stability, as recommended in a review of current management of metacarpal base fractures 2. Post-operative care typically includes 4-6 weeks of immobilization followed by progressive hand therapy to restore function. Without proper treatment, this injury can lead to chronic pain, decreased grip strength, and post-traumatic arthritis due to the articular involvement and joint subluxation. The noted osteoarthritis in the first CMC and interphalangeal joints represents chronic changes that may require separate management but are not part of the acute injury treatment. It's worth noting that the most recent and highest quality study on the treatment of intra-articular metacarpal base fractures recommends open reduction and internal fixation to ensure the integrity of the tendinous insertions 3. However, the specific details of the treatment plan may vary depending on the individual case and the surgeon's preference. In general, the goal of treatment is to restore joint congruity and stability, promote healing, and prevent long-term complications such as chronic pain and post-traumatic arthritis.