What is the treatment for metacarpal fractures using buddy taping (also known as buddy wrapping)?

From the Guidelines

Buddy taping is not recommended as the primary treatment for metacarpal fractures. Instead, metacarpal fractures typically require more substantial immobilization with a proper hand-based or forearm-based splint or cast, depending on the fracture location, displacement, and stability. For stable, non-displaced metacarpal fractures, a hand-based ulnar or radial gutter splint is usually appropriate, while unstable or displaced fractures may require closed reduction and casting or even surgical fixation. Buddy taping alone provides insufficient immobilization for metacarpal fractures because it fails to prevent rotation and angulation of the fractured bone during healing. This inadequate stabilization can lead to malunion, decreased grip strength, and functional limitations.

Key Considerations

• The diagnosis of metacarpal fractures is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies 1.
• Simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1.
• Buddy taping is more appropriate for phalangeal (finger) fractures, where it effectively uses the adjacent finger as a splint.
• If you encounter a suspected metacarpal fracture, proper evaluation with radiographs is essential, followed by appropriate splinting and orthopedic consultation for definitive management.

Management

• Pain control can be achieved with acetaminophen 650-1000mg every 6 hours and/or ibuprofen 400-600mg every 6 hours as needed, unless contraindicated.
• The treatment should prioritize preventing complications such as malunion, decreased grip strength, and functional limitations, which can significantly impact the patient's quality of life and morbidity.

From the Research

Treatment Overview

• Metacarpal fractures can be treated using buddy taping (also known as buddy wrapping) as a non-operative method 2, 3.
• This method involves immediate active protected mobilization, where the affected finger is taped to a neighboring finger for support 2.
• Buddy taping is typically used for stable, extra-articular fractures, and can be an effective treatment option for minimally displaced M2 to M5 fractures 2, 3.

Treatment Outcomes

• Studies have shown that buddy taping can result in good functional outcomes, with minimal pain, stiffness, and strength loss 2.
• The range of motion can be comparable to that of the contralateral side in 90% of cases after 2 months 2.
• However, secondary displacement can occur in some cases, highlighting the importance of careful patient selection and monitoring 2.

Comparison to Other Treatment Options

• Other treatment options for metacarpal fractures include non-operative management with immobilization, and operative management with osteosynthesis 4, 5, 6.
• The choice of treatment depends on the type and severity of the fracture, as well as patient factors and surgeon preference 4, 5, 6.
• Early mobilization is a critical component of treatment, regardless of the method used, to prevent stiffness and restore function 4, 5, 3.