From the Research
Surgical intervention for a fracture or osteoarthritis at the base of the fourth metacarpal is typically recommended when conservative treatments fail to provide adequate pain relief or functional improvement, or when there is significant displacement, instability, or deformity of the fracture. For fractures, surgery is indicated when there is more than 2mm of displacement, angulation greater than 10-15 degrees, rotational deformity, or instability that would lead to poor healing or functional outcomes. Some key points to consider when deciding on surgical intervention include:
- The patient's age, activity level, occupation, and the specific characteristics of the injury or disease
- The use of conservative measures such as NSAIDs (e.g. ibuprofen 400-800mg three times daily or naproxen 500mg twice daily), activity modification, splinting, and corticosteroid injections (typically methylprednisolone 40mg or triamcinolone 40mg mixed with lidocaine) 1, 2
- The choice of surgical procedure, which may include open reduction and internal fixation (ORIF) with plates and screws for fractures, or arthrodesis (fusion) or arthroplasty for severe osteoarthritis 3, 4
- The goal of surgery is to restore proper alignment, stability, and function of the hand while minimizing pain and preventing long-term complications such as malunion, nonunion, or progressive deformity that could significantly impair hand function 5 Recovery typically involves 4-6 weeks of immobilization followed by physical therapy focusing on range of motion exercises and gradual strengthening. It's worth noting that the current literature supports a wide array of treatment strategies, but high-level evidence to guide fracture management remains lacking 5. However, a thorough understanding of treatment modalities is helpful in evaluating and managing metacarpal fractures, and the ultimate goal is to maximize hand function with minimal morbidity 5.