From the Guidelines
A small bony avulsion injury at the first metacarpal phalangeal joint typically requires conservative management with immobilization, as surgery is usually reserved for large or significantly displaced fragments. The diagnosis of such an injury is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1. Treatment should begin with immobilization using a thumb spica splint for 3-4 weeks to allow the bone fragment to heal in proper position.
- Key considerations include:
- Immobilization to prevent further injury and allow healing
- Pain management with over-the-counter medications such as ibuprofen or acetaminophen
- Gradual progression to range-of-motion and strengthening exercises after immobilization
- According to the American College of Foot and Ankle Surgeons, simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1.
- The goal of conservative management is to allow the avulsed fragment to reattach to its original position through natural healing processes, which is feasible due to the good blood supply and healing potential of the thumb's metacarpal phalangeal joint.
- Surgery is rarely needed unless the fragment is large or involves a significant portion of the joint surface, emphasizing the importance of initial conservative management for small bony avulsion injuries at the first metacarpal phalangeal joint.
From the Research
Small Bony Avulsion Injury of the First Metacarpophalangeal Joint
- A small bony avulsion injury of the first metacarpophalangeal joint can result in significant functional impairment 2.
- The diagnosis of such injuries can be verified through clinical suspicion and sonographic assessment 2.
- Surgical repair with transosseous sutures or anchors can yield satisfactory results in the pediatric age group, with preservation of normal range of motion 2.
- The shape of the avulsed fragment is an important factor in determining the treatment approach, with triangular or rectangular fragments requiring surgical intervention due to involvement of the articular surface 3.
- Conservative treatment may be effective for round fragments, as the articular surface is not involved in this type of fracture 3.
Treatment Approaches
- Surgical repair is recommended for acute injuries with instability or displaced bony fragments, and should be performed within 4 weeks after the injury 4.
- Beyond this interval, ligament reconstruction is the preferred treatment approach 4.
- The choice of treatment approach depends on various factors, including the shape of the avulsed fragment, the presence of instability, and the patient's age and activity level 4, 3.
- A simple dislocation of the metacarpophalangeal joint can be reduced by closed means, whereas a complex dislocation may require surgical intervention 5.