From the Guidelines
For 2nd and 3rd metacarpal fractures, simple immobilization with a splint is appropriate when fracture fragments are small, nonarticular, or minimally displaced. The diagnosis of these fractures is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1. When considering treatment options, it's crucial to prioritize morbidity, mortality, and quality of life.
Key Considerations for Treatment
- The fracture's stability and displacement play a significant role in determining the treatment approach.
- For stable, non-displaced fractures, conservative management with immobilization is typically sufficient.
- The use of a splint for immobilization is recommended for small, nonarticular, or minimally displaced fracture fragments, as indicated by the American College of Foot and Ankle Surgeons 1.
- Pain management is also a critical component of treatment, often involving NSAIDs and acetaminophen.
Treatment Approach
- Immobilization with a splint for 4-6 weeks is a common approach for stable fractures, with the wrist positioned in slight extension and the metacarpophalangeal joints flexed.
- For unstable or displaced fractures, surgical intervention may be necessary, involving closed or open reduction with internal fixation.
- Post-operative care includes immobilization followed by progressive range of motion exercises to prevent stiffness and promote healing.
Given the information from 1, the focus should be on simple immobilization for fractures that are small, nonarticular, or minimally displaced, emphasizing the importance of proper fracture management to prevent long-term complications such as decreased grip strength and limited range of motion.
From the Research
Treatment Options for 2nd and 3rd Metacarpal Fracture
- The recommended treatment for a 2nd and 3rd metacarpal fracture includes the use of a functional hand-based splint, which allows for metacarpophalangeal joint, interphalangeal joint, and radiocarpal joint motion 2.
- This type of splint can be applied to any non-operative fracture of the second through the fifth metacarpal, and has been shown to allow for excellent maintenance of fracture reduction, early or immediate return to pre-injury activities, low patient morbidity, and maintains functional motion throughout treatment 2.
- Other treatment options, such as intramedullary splinting or conservative treatment, may also be considered, but the choice of treatment will depend on the specific characteristics of the fracture and the patient's individual needs 3.
- In some cases, interosseous loop wire fixation and immediate postoperative finger mobilisation in a wrist splint may be used to treat metacarpal shaft fractures, allowing for good functional results 4.
- A modified functional casting technique, such as a glove cast, may also be used to treat closed metacarpal fractures in athletes, allowing for maintenance of wrist and forearm function during the period of immobilization and protection from reinjury 5.
- Postoperative treatment of metacarpal fractures may include a home exercise program or traditional physical therapy, both of which have been shown to be effective in improving range of motion and grip strength 6.