What is the treatment for a 5th metacarpal fracture?

Treatment of 5th Metacarpal Fractures

For 5th metacarpal fractures, rigid immobilization with splinting is the preferred treatment for displaced fractures, while functional taping may be used for stable, minimally displaced fractures to allow earlier functional recovery. 1, 2

Assessment and Classification

• Evaluate for obvious deformity, swelling, bruising, severe pain with movement, or inability to move the affected digit 1, 2
• Radiographic assessment should be performed with upright radiographs to better demonstrate the degree of displacement 1
• Two-view radiographs (PA and lateral) are typically sufficient for diagnosis of metacarpal fractures 3

Treatment Algorithm

Non-operative Management (First-line for most 5th metacarpal fractures)

• Indications for non-operative treatment:

  • No joint involvement
  • No malrotation
  • Angulation less than 30 degrees
  • Shortening less than 5 mm 4

• Immobilization options:

  • Rigid immobilization with splinting is preferred over removable splints for displaced fractures 1, 2
  • Functional taping can be used for stable fractures and provides quicker functional recovery compared to plaster casting 5
  • Cast immobilization should position the hand with the metacarpophalangeal joint in 60-90 degrees of flexion 4

Surgical Management

• Indications for surgical intervention:

  • Open fractures 2
  • Multiple/serial fractures 4
  • Displacement over 30 degrees that cannot be adequately reduced 4
  • Intra-articular fractures with displacement 6
  • Unstable fractures 7

• Surgical options:

  • Percutaneous pinning with Kirschner wires for most fracture patterns requiring fixation 2, 6
  • Open reduction with multiple Kirschner pins for comminuted fractures or when closed restoration of articular surface is not feasible 6
  • Intramedullary stabilization for significantly displaced fractures (>30 degrees) 4
  • Headless screw fixation may be considered in certain cases 8

Rehabilitation

• Early finger motion exercises should be initiated to prevent stiffness 9
• Rehabilitation should include:
  • Muscle strengthening exercises 1, 2
  • Long-term continuation of hand exercises 1, 2
  • Patient education about pain management strategies 1, 2
  • Patient education about rehabilitation exercises 1, 2

Follow-up and Complications

• Monitor for signs of complications requiring medical attention 1, 2
• If a fractured extremity appears blue, purple, or pale, immediate emergency medical care is necessary 2
• Radiographic follow-up at approximately 3 weeks and at the time of immobilization removal 9
• Common pitfalls to avoid:
  • Attempting closed reduction of significantly displaced 5th metacarpal fractures (boxer's fractures) as this is often unsuccessful 4
  • Inadequate reduction may result in pain, functional disability, and osteoarthritic changes 6
  • Failure to identify and address rotational deformity, which can lead to finger overlap and significant functional impairment 7