What is the recommended treatment for a distal 2nd metacarpal fracture?

Treatment of Distal 2nd Metacarpal Fracture

The recommended treatment for a distal 2nd metacarpal fracture is immobilization with a hand-based functional splint for approximately 3-4 weeks, allowing for metacarpophalangeal joint, interphalangeal joint, and radiocarpal joint motion to prevent stiffness while maintaining fracture stability. 1

Initial Assessment and Management

• Radiographic evaluation: Standard radiographs are the first-line imaging modality to assess fracture patterns and guide treatment decisions 2
• Pain management:
  • Cold therapy (20-30 minutes, 3-4 times daily) to improve pain and reduce swelling 2
  • NSAIDs for pain and inflammation control 2

Treatment Algorithm

Non-operative Management (First-line for most cases)

1. Immobilization with a hand-based functional splint 1

   • Average splint duration: 24 days
   • Allows for maintenance of functional motion throughout treatment
   • Permits early return to activities while maintaining fracture reduction

2. Benefits of functional splinting 1

   • Excellent maintenance of fracture reduction
   • Low patient morbidity
   • Maintains functional motion during healing
   • Can be applied to non-operative fractures of the 2nd metacarpal

Surgical Management (For specific cases)

Surgical intervention is indicated for:

• Unstable fractures
• Significantly displaced fractures
• Fractures with rotational deformity
• Multiple fractures

When surgery is necessary, options include:

• Open reduction and internal fixation with screws and plates 3
  • Provides stable fixation
  • Allows for early mobilization (average 7 days post-op)
  • Results in consistent union without deformity

Rehabilitation and Follow-up

• Early mobilization is critical to prevent stiffness and restore function 4
• Directed home exercise program including active finger motion exercises to prevent stiffness 2
• Follow-up radiographs to assess healing, with advanced imaging (CT or MRI) if symptoms persist despite normal radiographs 2

Special Considerations

• Athletes: May benefit from modified functional casting technique allowing earlier return to modified activity (within 2 weeks) and full participation by 4 weeks 5
• Diabetic patients: Require close monitoring for pressure points and skin breakdown 2
• Elderly patients: Should be evaluated for osteoporosis and considered for calcium and vitamin D supplementation 2
• Smokers: At increased risk for nonunion and inferior clinical outcomes 2

Potential Complications

• Joint stiffness (most common complication)
• Chronic pain
• Post-traumatic arthritis
• Extensor lag
• Delayed union or malunion

The functional hand-based splint approach has demonstrated excellent outcomes with 27 of 30 patients showing no change in alignment from start to end of treatment, and the remaining three maintaining acceptable alignment within non-operative criteria 1.