From the Guidelines
Surgery is the usual treatment for a second metacarpal fracture, with simple immobilization being appropriate when fracture fragments are small, nonarticular, or minimally displaced. When considering treatment options for a second metacarpal fracture, it's essential to prioritize morbidity, mortality, and quality of life as the outcome. According to the American College of Foot and Ankle Surgeons, the diagnosis of a second metacarpal fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1.
Treatment Options
- For non-displaced fractures, treatment involves immobilization with a short arm cast or a thumb spica splint for 4-6 weeks, with the wrist in slight extension and the metacarpophalangeal joint in slight flexion to prevent stiffness.
- Pain management includes acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) for 5-7 days.
- Regular follow-up with radiographs at 1-2 weeks and then at 4-6 weeks is necessary to ensure proper healing.
- For displaced fractures, surgical fixation with K-wires, screws, or plates is typically required to restore proper alignment and function, as stated in the study 1.
Post-Treatment Care
- Post-surgical care includes immobilization for 2-4 weeks followed by progressive range of motion exercises and physical therapy to restore hand function.
- Early mobilization of uninvolved digits is important in all cases to prevent stiffness.
- The second metacarpal is crucial for hand function, particularly for grip strength and precision movements, making proper alignment essential for optimal functional outcomes.
Given the information from the study 1, it's clear that the treatment approach should prioritize proper alignment and function to ensure the best possible outcome for the patient, focusing on minimizing morbidity, mortality, and maximizing quality of life.
From the Research
Treatment Options for Second Metacarpal Fracture
- The majority of metacarpal fractures, including those of the second metacarpal, can be managed non-operatively 2.
- Non-operative treatment may involve the use of a functional hand-based splint, which allows for metacarpophalangeal joint, interphalangeal joint, and radiocarpal joint motion 3.
- Splints can maintain fracture reduction and angulation comparable to casting, with additional benefits of reduced costs, improved patient hygiene, and satisfaction 4.
- When surgical intervention is indicated, various methods of fixation are available, including intramedullary Kirschner wiring (KW) and intramedullary compression screws (IS) 5.
- The choice of fixation method depends on the injury pattern, patient function, and surgeon preference, with early mobilization being a critical component of treatment to prevent stiffness and restore function 2, 5.
Indications for Surgical Intervention
- Surgical intervention may be necessary for metacarpal fractures with intraarticular involvement, malrotation, shortening greater than 6 mm, or excessive angulation 6.
- Patients with such fractures require referral to an orthopedic surgery subspecialist for possible surgical intervention 6.
- Intraarticular and extraarticular metacarpal fractures of the thumb are subject to tendon forces and often displace, requiring surgical intervention 6.
Outcomes of Treatment
- The primary outcome of total active range of motion (TAM) and rotation, as well as the secondary outcome of splint time, return to work, bone healing, and complication rates, showed no significant difference between KW and IS fixation methods 5.
- A hand-based functional splint can allow for excellent maintenance of fracture reduction, early or immediate return to pre-injury activities, low patient morbidity, and maintains functional motion throughout treatment 3.