From the Guidelines
For a 5th metacarpal fracture, simple immobilization with a splint is the appropriate treatment when fracture fragments are small, nonarticular, or minimally displaced. This approach is supported by the American College of Foot and Ankle Surgeons, as noted in a study published in the American Family Physician in 2002 1. The goal of splinting is to immobilize the fracture site while maintaining the hand in a functional position to prevent stiffness and contractures.
Key Considerations for Splinting
- The splint should be applied in a way that immobilizes the wrist in slight extension and the metacarpophalangeal (MCP) joints at 70-90 degrees of flexion.
- The interphalangeal joints should be placed in slight flexion, known as the "safe position," to promote proper healing and prevent complications.
- The duration of splint wear depends on the severity of the fracture and the progress of healing, typically ranging from 3-4 weeks for non-displaced fractures.
Post-Splinting Care
- Patients should elevate the hand above heart level when possible to reduce swelling.
- Prescribed pain medication should be taken as needed to manage discomfort.
- Active motion of the uninvolved digits should be encouraged to prevent stiffness.
- After the initial immobilization period, gradual range of motion exercises should begin under the guidance of a healthcare provider to ensure proper recovery and prevent long-term functional impairment.
From the Research
Types of Splints for 5th Metacarpal Fracture
- Ulnar gutter splint: a simple and proven method for immobilizing boxer's fractures, which are isolated fractures of the distal fourth or fifth metacarpal bones 2
- Functional metacarpal splint (FMS): yields faster improvement in clinical scores with earlier gain of normal grip strength compared to ulnar gutter splint (UGS) in stable 5th metacarpal neck fractures 3
Comparison of Splints
- 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 in stable 5th metacarpal neck fractures 3
- However, in the long term, both FMS and UGS methods yield similar radiological and clinical outcomes 3
- Patient comfort and compliance may be better with FMS due to less joint restriction 3
Rehabilitation Programs
- Limited evidence is available on hand rehabilitation programs for second to fifth metacarpal fractures, with a need for further investigation on the effect of hand rehabilitation after conservative and surgical management 4
- A well-designed, well-implemented home-based exercise program may result in statistically significant improved hand function and digital total active motion compared to traditional physiotherapy post-surgically 4