What is the treatment for a non-displaced fifth metacarpal base fracture?

Treatment of Non-Displaced Fifth Metacarpal Base Fracture

Non-displaced fifth metacarpal base fractures should be treated with functional taping or a short period of immobilization with a cast or splint, followed by early range of motion exercises to prevent stiffness. 1

Initial Management

• Immobilization Options:

  • Functional taping is preferred over cast immobilization as it allows for earlier functional recovery 2
  • If using a cast, a short arm cast or ulnar gutter splint is appropriate
  • Immobilization period should be short (<10 days) to decrease pain and edema while preventing stiffness 1

• Positioning:

  • The wrist should be in slight extension
  • The metacarpophalangeal joints should be in flexion (70-90 degrees)
  • The interphalangeal joints should remain free to allow motion

Follow-up Care

• Early Rehabilitation:

  • Active finger motion exercises should begin immediately to prevent stiffness 1
  • Ice application during the first 3-5 days can provide symptomatic relief
  • Progressive range of motion exercises should be started after the immobilization period

• Radiographic Follow-up:

  • Radiographs should be obtained at 3 weeks and at cessation of immobilization 1
  • Most fractures unite within 12 weeks

Surgical Indications

While non-displaced fifth metacarpal base fractures generally don't require surgery, it's important to recognize when surgical intervention might be necessary:

• Displacement >5mm in any plane
• Intra-articular displacement
• Unstable fracture patterns
• Comminuted fractures where closed restoration of the articular surface is not possible 3

Potential Complications

• Excessive immobilization risks:

  • Joint stiffness
  • Muscle atrophy
  • Chronic pain
  • Complex regional pain syndrome 1

• Inadequate treatment may result in:

  • Pain
  • Functional disability
  • Osteoarthritic changes 3

Clinical Pearls

• Non-displaced fractures have excellent outcomes with conservative management
• Functional taping shows significant earlier functional recovery compared to cast immobilization 2
• After 6 months, there are typically no significant differences between functional and anatomical results regardless of immobilization method 2
• CT imaging may be necessary if there is suspicion of associated carpal injuries or complex fracture patterns 4, 5
• For metacarpal fractures, CT is usually not indicated during acute injury unless there is suspicion of carpometacarpal joint involvement 4

By following these guidelines, most non-displaced fifth metacarpal base fractures will heal well with minimal long-term functional impairment.