Can a Salter Harris type 2 fracture of the third and fourth metacarpal be treated with a Donjoy (thumb spica long brace)?

Management of Salter-Harris Type 2 Fractures of Third and Fourth Metacarpals

A Salter-Harris type 2 fracture of the third and fourth metacarpals can be effectively treated with a thumb spica long brace such as a Donjoy brace, particularly for minimally displaced fractures with stable reduction.

Assessment and Initial Management

When evaluating a Salter-Harris type 2 fracture of the metacarpals:

1. Radiographic evaluation:

   • Standard radiographs (posteroanterior, lateral, and oblique views) are recommended for initial diagnosis 1
   • Assess for displacement, angulation, and stability of the fracture

2. Fracture characteristics that determine treatment approach:

   • Displacement (<3mm vs ≥3mm)
   • Stability of the fracture after reduction
   • Involvement of the joint surface
   • Presence of soft tissue interposition

Treatment Algorithm

For minimally displaced fractures (<3mm):

• Immobilization with a thumb spica long brace (Donjoy) is appropriate 2
• Benefits include:
  • Protection of the fracture site
  • Reduction of pain and swelling
  • Facilitation of healing
  • Prevention of further displacement

For significantly displaced fractures (≥3mm):

1. Initial closed reduction should be attempted
2. If reduction is successful and stable:
   • Immobilization with thumb spica brace is appropriate
3. If reduction is unsuccessful or unstable:
   • Surgical intervention may be necessary (similar to findings in other Salter-Harris fractures) 3

Follow-up and Monitoring

• Regular radiographic assessment to ensure proper healing
• Monitor for signs of premature physeal closure, which is a common complication in Salter-Harris fractures 3
• Watch for digital hyperextension after brace removal, which may be transient 4

Potential Complications

• Growth disturbance: Salter-Harris fractures involve the growth plate and can lead to premature physeal closure
• Joint stiffness: Prolonged immobilization can lead to stiffness 5
• Malunion: Improper healing may result in functional limitations

Important Considerations

• Age of the patient: Younger patients have greater remodeling potential
• Hand dominance: May influence functional outcomes and rehabilitation needs
• Duration of immobilization: Limiting immobilization duration can reduce complications such as stiffness 5

Rehabilitation

• After immobilization period (typically 4-6 weeks):
  • Implement a directed home exercise program including active motion exercises to prevent stiffness 5
  • Gradually increase range of motion and strength exercises

Caveat

While the evidence specifically addressing Salter-Harris type 2 fractures of the third and fourth metacarpals is limited, treatment principles from similar fractures can be applied. The thumb spica brace provides adequate immobilization while allowing for some functional use of the hand during healing.