From the Guidelines
The conservative treatment approach for pediatric metacarpal fractures typically involves immobilization with a cast or splint for 3-4 weeks. For stable, non-displaced fractures, a short-arm cast or ulnar gutter splint with the metacarpophalangeal joint flexed at 70-90 degrees and the interphalangeal joints free is recommended. Analgesics such as acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) can be used for pain management. Weekly radiographic follow-up for the first 2-3 weeks is important to ensure the fracture remains properly aligned. Children generally heal faster than adults, with complete healing often occurring within 3-6 weeks. Conservative management is particularly successful in children due to their remarkable remodeling potential, especially in younger patients and fractures near the growth plate. Even angulation up to 20-30 degrees and rotation under 5 degrees can be accepted in many pediatric metacarpal fractures, as these will often remodel with growth. However, rotational deformities must be corrected as they do not remodel well and can cause functional problems with finger overlap during flexion. The provided evidence does not directly address pediatric metacarpal fractures, but general principles of fracture management can be applied, as seen in studies such as 1, which discusses the importance of proper alignment and immobilization in fracture treatment. It's also worth noting that while studies like 1 discuss complex fractures and their management, the key takeaway for pediatric metacarpal fractures remains the focus on conservative management and the potential for significant remodeling. Thus, the approach should prioritize immobilization and regular follow-up, with a focus on pain management and monitoring for any complications that may require surgical intervention, as generally recommended in orthopedic care 1.
From the Research
Conservative Treatment Approach
The conservative treatment approach for pediatric metacarpal fractures involves non-surgical management, with the primary goals of achieving anatomic and stable reduction, bony union, and early mobilization to minimize disability 2. This approach is often preferred for stable or minimally displaced fractures.
Key Principles
- Appropriate reduction and immobilization are crucial for successful conservative treatment 2, 3.
- Early mobilization is essential to minimize disability and promote functional outcomes 2, 4.
- A custom-molded splint can be used to allow motion of the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, promoting bone healing and recovery of motion simultaneously 4.
Treatment Options
- Closed reduction and immobilization can be effective for displaced fractures, with functional mobilization started after 1 week 5.
- A protected reduction and mobilization program using a custom-molded thermoplastic splint can be used for displaced proximal phalanx and metacarpal fractures 4.
- Cast immobilization can be used for carpal fractures, with clinical follow-up examination after 10 to 14 days and MRI performed if necessary 6.
Outcomes
- Conservative treatment can provide safe, rapid recovery while maintaining normal active range of motion 3.
- Functional outcomes depend on appropriate treatment and early range of motion whenever possible 2.
- Patient satisfaction and appearance can be superior with surgical treatment, but no significant differences in range of motion and grip strength were found between surgical and conservative treatment groups 5.