From the Guidelines
For a 2nd and 3rd metacarpal fracture, an ulnar gutter splint is the recommended type of splint. This recommendation is based on the principle of immobilizing the fracture site while maintaining proper alignment of the metacarpal bones and preventing rotation, as implied by general orthopedic principles 1. The ulnar gutter splint extends from the forearm to just beyond the fingertips, encompassing the ring and small fingers while leaving the thumb free. The splint should be applied with the hand in the "safe position" - wrist slightly extended (20-30 degrees), metacarpophalangeal joints flexed at 70-90 degrees, and interphalangeal joints slightly flexed. Some key points to consider when using a splint for metacarpal fractures include:
- Immobilization usually lasts 3-4 weeks for stable, non-displaced fractures, followed by progressive mobilization and rehabilitation.
- The splint design helps prevent stiffness by keeping the collateral ligaments of the metacarpophalangeal joints stretched.
- For severely displaced or unstable fractures, surgical fixation may be necessary before splinting.
- Regular follow-up with radiographic evaluation at 1-2 weeks is important to ensure the fracture remains properly aligned during healing. It's also worth noting that while splinting can be beneficial, it's essential to weigh the benefits against potential harms, such as increased attention and focus to the area, accessory muscle use, compensatory movement strategies, immobilization leading to muscle deconditioning, learnt non-use, and increased pain, as discussed in the context of functional neurological disorders 1. However, in the case of metacarpal fractures, the use of an ulnar gutter splint is a well-established practice aimed at promoting proper healing and minimizing complications.
From the Research
Recommended Splint Type
The recommended splint type for a 2nd and 3rd metacarpal fracture is:
- A hand-based functional splint 2
- A thermoplastic splint 3, 4, 5
- A functional metacarpal splint (FMS) 6
Key Characteristics
Key characteristics of the recommended splints include:
- Allowing metacarpophalangeal joint, interphalangeal joint, and radiocarpal joint motion 2
- Being custom fabricated preoperatively by a specialist hand therapist 3
- Having a thumb stabilizing component to maintain the forearm in a stable pronated position 3
- Providing excellent maintenance of fracture reduction, early or immediate return to pre-injury activities, low patient morbidity, and maintaining functional motion throughout treatment 2
Comparison of Splint Types
Comparing different splint types, studies have found that:
- Hand-based thermoplastic splints resulted in improved early range of motion and grip strength, with no increased pain, nonadherence, or complications compared to conventional ulnar gutter splints 4
- Functional metacarpal splints (FMS) yielded faster improvement in clinical scores with earlier gain of normal grip strength compared to ulnar gutter splints (UGS), although both methods yielded similar radiological and clinical outcomes in the long term 6