Management of Mildly Displaced 3rd Metacarpal Shaft Fracture
For mildly displaced 3rd metacarpal shaft fractures, conservative management with splinting is the recommended treatment, allowing for fracture immobilization while maintaining finger motion to prevent stiffness. 1
Assessment and Diagnosis
- Initial evaluation should include a 3-view radiographic examination (posteroanterior, lateral, and 45° semipronated oblique) to confirm the diagnosis and assess fracture characteristics 1, 2
- Evaluate for:
Treatment Algorithm
Conservative Management (First-Line)
- Apply a hand-based splint that immobilizes the fracture site while allowing for finger motion 1, 4
- The splint should:
- Maintain the metacarpophalangeal joint in 60-90° of flexion
- Allow for interphalangeal joint motion
- Permit radiocarpal joint motion 4
- Duration of splinting is typically 3-4 weeks 1, 4
- Encourage active finger motion exercises immediately following diagnosis to prevent stiffness 1, 4
Surgical Management (Consider if):
- Displacement >3mm
- Dorsal tilt >10°
- Intra-articular involvement
- Rotational deformity
- Unstable fracture pattern 1, 3
Follow-up and Monitoring
- Radiographic follow-up at approximately 3 weeks to confirm adequate healing 1
- Assess for:
Rehabilitation
- Active finger motion exercises should be performed throughout treatment 1, 4
- A functional hand-based splint allows for excellent maintenance of fracture reduction while maintaining functional motion throughout treatment 4
- Early mobilization is critical to minimize stiffness and optimize outcomes 5, 4
Common Pitfalls and Caveats
- Failure to recognize rotational deformity can lead to finger overlap and functional impairment 3
- Overly rigid immobilization can lead to unnecessary stiffness and prolonged rehabilitation 4
- Inadequate immobilization may lead to loss of reduction 6
- A recent study showed that 27 of 30 patients treated with a functional hand-based splint maintained proper alignment throughout treatment, with the remaining three showing minimal changes that remained within non-operative criteria 4
- The same study demonstrated that 20 out of 24 employed patients were able to continue working without missing any days when treated with a functional hand-based splint 4
Special Considerations
- For fractures with significant displacement (>3mm), dorsal tilt (>10°), or intra-articular involvement, surgical management may be indicated instead of conservative treatment 1
- Twin-tape fixation can be considered once soft-tissue swelling has resolved to allow for more functional treatment 6
- The primary goals of treatment are to achieve anatomic and stable reduction, bony union, and early mobilization to minimize disability 5