What is the treatment for a thumb fracture?

Treatment for Thumb Fractures

Thumb fractures should be treated based on fracture location and displacement: minimally displaced extra-articular fractures can be managed with removable splinting and early motion exercises, while displaced intra-articular fractures require surgical fixation to restore joint congruity and prevent long-term disability. 1

Initial Diagnostic Evaluation

• Obtain 3-view radiographs (PA, lateral, and oblique) of the hand to confirm diagnosis and assess fracture characteristics 1
• Consider CT without IV contrast when initial radiographs are equivocal or for preoperative planning of complex articular injuries 1
• Three-dimensional CT reconstructions are particularly valuable for surgical planning of intra-articular fractures 1

Treatment Algorithm by Fracture Type

Extra-Articular Thumb Fractures (Minimally Displaced)

• Use removable splints for stable, minimally displaced fractures 1
• The splint should be padded and comfortably tight without being constrictive 2
• Immobilize for 3-4 weeks with radiographic follow-up at approximately 3 weeks to assess healing 2

Extra-Articular Thumb Fractures (Displaced)

• Displaced fractures of the distal and proximal phalanx typically require operative fixation with screws or Kirschner wires 3
• Fractures of the first metacarpal base (Winterstein fractures) usually require reduction and fixation due to displacement from abductor pollicis longus tendon traction 3

Intra-Articular Thumb Fractures

• Surgical fixation is indicated for fractures with post-reduction radial shortening >3 mm, dorsal tilt >10°, or intra-articular displacement 1
• Bennett and Rolando fractures (intra-articular base of first metacarpal) require reduction and fixation to prevent carpometacarpal joint arthritis 3
• Small avulsion fractures at the metacarpophalangeal joint can be treated with tension wire fixation to restore joint stability and congruity 4

Critical Rehabilitation Protocol

Early Motion Exercises

• Begin active finger motion exercises immediately during immobilization to prevent stiffness—this is the single most important intervention to prevent long-term disability 1
• Hand stiffness is one of the most functionally disabling complications following hand fractures 1
• Active motion exercises are extremely cost-effective and do not adversely affect adequately stabilized fractures 2
• A home exercise program is appropriate for most patients after thumb fracture treatment 1

Duration and Follow-up

• Continue immobilization for 3-4 weeks with radiographic reassessment 2
• Monitor for complications including skin irritation, muscle atrophy, joint stiffness, and complex regional pain syndrome 1

Pain Management Strategy

• Use multimodal and opioid-sparing protocols when possible 1
• Options include local anesthetics, NSAIDs, acetaminophen, ice, elevation, and compression 1
• Consider vitamin C supplementation for prevention of disproportionate pain during recovery 1

Special Considerations for Elderly Patients

• A balanced approach regarding operative versus non-operative treatment is required for elderly patients with fragility fractures 5
• Patient factors including functional status, comorbidities, and bone quality must guide treatment decisions 5

Common Pitfalls to Avoid

• Over-immobilization is a critical error: rigid splinting when simpler immobilization would suffice leads to unnecessary stiffness 2
• Inadequate initial radiographs: always obtain three views including oblique projections 2
• Failing to initiate early motion exercises results in preventable long-term functional impairment 1
• Missing intra-articular displacement on initial radiographs can lead to post-traumatic arthritis if not surgically addressed 1