From the Guidelines
For a fracture of the second metacarpal bone, an ulnar gutter splint is typically recommended as the initial treatment. This recommendation is based on the principle of immobilizing the fracture site to allow proper healing, as suggested by the concept of simple immobilization being appropriate for small, nonarticular, or minimally displaced fracture fragments 1.
Key Considerations for Splinting
- The splint should extend from the distal forearm to the fingertips, immobilizing the wrist in slight extension (about 20-30 degrees), the metacarpophalangeal joints in 70-90 degrees of flexion, and the interphalangeal joints in slight flexion.
- It is crucial to include the ring and small fingers along with the index finger in the splint to provide adequate stabilization while leaving the thumb free for function.
- The application of the splint should include padding to prevent pressure sores, and it should be secured with an elastic bandage, ensuring it is not too tight to avoid compromising circulation.
Duration and Monitoring
- Immobilization typically lasts 3-4 weeks for non-displaced fractures, followed by progressive mobilization and rehabilitation exercises.
- It is essential to elevate the hand above heart level initially to reduce swelling and to monitor for signs of compartment syndrome, including increasing pain, paresthesia, pallor, or paralysis, which would require immediate medical attention. The ulnar gutter splint is effective because it prevents rotation and angulation of the fracture while maintaining the functional position of the hand, which is critical for minimizing morbidity and promoting quality of life during the recovery period.
From the Research
Metacarpal Fracture Treatment
The treatment of metacarpal fractures, including those of the second metacarpal bone, can vary depending on the severity and location of the fracture.
- For non-operative management, a functional hand-based splint can be used, as seen in a study by 2, which allowed for metacarpophalangeal joint, interphalangeal joint, and radiocarpal joint motion.
- This type of splint has been shown to maintain fracture reduction, allow for early return to pre-injury activities, and maintain functional motion throughout treatment.
Splinting for Second Metacarpal Fractures
For fractures of the second metacarpal, a hand-based functional splint can be applied, as mentioned in the study by 2.
- This splint can be used for non-operative fractures of the second through the fifth metacarpal.
- The average splint duration was 24 days, and most patients were able to continue working without missing any days.
Alternative Treatment Options
Other treatment options, such as intramedullary Kirschner wiring (KW) or intramedullary compression screws (ISs), may be used for unstable or complex fractures, as discussed in the study by 3.
- However, for a fracture of the second metacarpal bone, a functional hand-based splint may be a suitable option, as it allows for maintenance of fracture reduction and functional motion.