From the Guidelines
For a 4th metacarpal fracture, I recommend an ulnar gutter splint as the primary immobilization method, as it provides direct support to the ulnar side of the hand and prevents rotation and angulation of the fracture. This recommendation is based on the principle that simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced, as stated in the study by the American College of Foot and Ankle Surgeons 1. The ulnar gutter splint should extend from the distal forearm to just beyond the fingertips, with the wrist positioned in slight extension (20-30 degrees), the metacarpophalangeal (MCP) joints flexed at 70-90 degrees, and the interphalangeal joints in slight flexion.
- Key considerations for the application of the ulnar gutter splint include:
- Immobilizing the 4th and 5th digits while allowing some function of the thumb, index, and middle fingers
- Wearing the splint continuously for approximately 3-4 weeks, depending on fracture stability and healing progress
- Following up with radiographs to assess alignment and ensure proper healing The position of safe immobilization, maintained by the ulnar gutter splint, helps prevent stiffness and contractures by keeping the collateral ligaments of the MCP joints at their maximal length during healing, thus prioritizing morbidity, mortality, and quality of life as the outcome.
From the Research
Recommended Splint for 4th Metacarpal Fracture
- A hand-based functional splint can be used for non-operative treatment of 4th metacarpal fractures, allowing for excellent maintenance of fracture reduction, early return to pre-injury activities, and low patient morbidity 2.
- Transverse pinning with Kirchner wires can also be an effective treatment option, providing stable fixation, minimal joint and soft tissue injury, and allowing for early mobilization 3.
- Percutaneous reduction and intermetacarpal K-wire fixation is another technique that can achieve stable and reliable fixation, with good hand function 4, 5.
Key Considerations
- The choice of splint or fixation technique may depend on the specific characteristics of the fracture, such as angulation, rotation, and shortening.
- Closed reduction and percutaneous intermetacarpal K-wire fixation with external fixation can be a useful technique for treating isolated fourth metacarpal neck fractures 5.
- Bioabsorbable screws may also be considered for internal fixation of proximal fractures of the 2nd and 4th metacarpal bones, although this technique is more commonly used in veterinary medicine 6.