What is the treatment for a fractured metacarpal (metacarpal bone)?

From the Guidelines

For a fractured metacarpal, the treatment of choice is simple immobilization when fracture fragments are small, nonarticular, or minimally displaced, while surgery is considered for more complex cases. The diagnosis of a metacarpal fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1. When treating a fractured metacarpal, it is essential to follow a step-by-step approach to ensure proper healing and minimize complications.

Initial Management

• Follow the RICE protocol: rest the hand, apply ice for 15-20 minutes every 2-3 hours, compress with a soft bandage, and elevate the hand above heart level to reduce swelling.
• Pain management typically includes acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) if not contraindicated.

Treatment Options

• Non-displaced fractures often require immobilization with a cast or splint for 4-6 weeks.
• Displaced fractures may need surgical intervention with pins, screws, or plates, as indicated by the american college of foot and ankle surgeons 1.

Recovery

• During recovery, follow your doctor's guidance on hand exercises to restore strength and mobility.
• Metacarpal fractures typically heal within 6-8 weeks, though complete recovery may take several months.
• Proper treatment is crucial to prevent long-term complications like decreased grip strength, stiffness, or malunion that could affect hand function.

From the Research

Treatment Options for Metacarpal Fractures

The treatment for metacarpal fractures can vary depending on the severity and type of fracture. Some common treatment options include:

• Non-operative management with immobilization and early mobilization 2, 3, 4
• Surgical intervention with various methods of fixation, such as open reduction and internal fixation 2, 5
• Use of a hand-based splint to maintain fracture reduction and allow for early return to pre-injury activities 6

Indications for Surgical Intervention

Surgical intervention is typically indicated for:

• Unstable or significantly displaced fractures 4, 5
• Open fractures 5
• Serial fractures of the metacarpal bone 5
• Displacement of over 30 degrees or shortening of over 5 mm 5

Non-Operative Management

Non-operative management is often recommended for:

• Stable, non-displaced fractures 3, 4, 5
• Fractures with minimal displacement or angulation 5
• Patients who are able to maintain reduction and participate in early mobilization 2, 3, 4

Use of Splints and Immobilization

Splints and immobilization can be used to:

• Maintain fracture reduction 6
• Allow for early mobilization and return to pre-injury activities 2, 3, 6
• Minimize patient morbidity and maintain functional motion throughout treatment 6