What type of splint is recommended for a distal fifth metacarpal fracture?

Splinting for Distal Fifth Metacarpal Fractures

A functional hand-based splint is the recommended treatment for distal fifth metacarpal fractures as it allows for better functional recovery while maintaining adequate fracture reduction. 1, 2

Splint Options and Evidence

Recommended Splint Types

• Functional hand-based splint/Functional metacarpal splint (FMS):

  • Allows motion of metacarpophalangeal (MCP), interphalangeal (IP), and radiocarpal joints 1
  • Provides excellent maintenance of fracture reduction 1
  • Enables earlier return to function and work activities 1, 2
  • Results in faster improvement in clinical scores and earlier return to normal grip strength 2

• Ulnar gutter splint (UGS):

  • Traditional option for fifth metacarpal fractures 3
  • More restrictive of joint motion 2
  • May lead to slower functional recovery 4, 2

Comparative Evidence

A 2023 study demonstrated that a hand-based functional splint:

• Maintained fracture reduction in 90% of cases (27/30 patients) 1
• Allowed 83% of employed patients (20/24) to continue working without missing days 1
• Required an average splint duration of 24 days 1

A 2019 comparative study showed that functional metacarpal splints:

• Led to significant improvement in QuickDASH scores between 2nd and 6th month follow-up 2
• Enabled patients to reach expected grip strength values by the 2nd month 2
• Provided better patient comfort due to less joint restriction 2

Earlier research from 1998 demonstrated that functional taping resulted in significantly earlier functional recovery compared to plaster immobilization 4

Application Guidelines

When to Use Functional Hand-Based Splint

• Stable fifth metacarpal fractures 1, 2
• Minimally displaced fractures 1
• When early return to function is prioritized 1

When to Consider Alternative Treatment

• Unstable fractures with significant displacement
• Fractures with rotational deformity
• Patients with poor compliance

Follow-up and Monitoring

• Regular radiographic assessment to ensure maintenance of reduction
• Typical splint duration: 3-4 weeks 1
• Monitor for:
  • Changes in alignment
  • Joint stiffness
  • Grip strength recovery

Common Pitfalls and Caveats

• Even with functional splinting, some loss of initial reduction may occur in the first month 2
• Long-term outcomes (at 6 months) appear similar between functional splints and ulnar gutter splints, so the main advantage is earlier return to function 2
• Patient compliance and comfort should be considered when selecting splint type 2
• For office workers and those requiring earlier return to work, functional splinting is particularly beneficial 1, 5

Rehabilitation Considerations

• Early mobilization helps prevent stiffness and promotes optimal recovery
• A directed home exercise program including active motion exercises should be implemented
• Limiting immobilization duration reduces complications