From the Research
A short arm cast or percutaneous reduction and intermetacarpal K-wire fixation is typically recommended for a fourth metacarpal shaft fracture, as it provides stable and reliable fixation with good hand function, as shown in a study published in 2021 1. The choice of treatment depends on the severity of the fracture, with casting being suitable for less severe cases and surgical intervention being necessary for more severe or displaced fractures.
- The cast should extend from below the elbow to the distal palmar crease, including the wrist and hand while leaving the fingers and thumb free to move.
- The wrist should be in slight extension (about 20-30 degrees) and the metacarpophalangeal joints flexed at approximately 70-90 degrees (the "intrinsic plus" position) to prevent stiffness and maintain proper alignment.
- The cast is usually worn for 4-6 weeks, depending on fracture stability and healing progress.
- Regular follow-up x-rays at 1-2 week intervals are important to ensure the fracture remains properly aligned, as noted in various studies, including one published in 2005 2 and another in 2016 3.
- For significantly displaced or rotated fractures, surgical intervention with intramedullary absorbable implants may be necessary, as shown in a study published in 2015 4, which demonstrated good early clinical outcomes with this method.
- The goal of treatment is to achieve proper alignment, prevent stiffness, and maintain hand function, with the choice of treatment depending on the individual case and the severity of the fracture, as discussed in a study published in 1997 5.