How long should a patient with an angulated transverse fracture of the 5th metacarpal wear a brace before seeing a healthcare provider?

Immobilization Duration for Angulated 5th Metacarpal Fracture

Splint the fracture in the position found and have the patient see a healthcare provider within 24-48 hours for definitive evaluation and treatment planning. 1

Immediate First Aid Management

• Do not attempt to straighten or realign the angulated fracture before splinting, as there is no evidence supporting this practice and it risks neurovascular injury 1, 2
• Splint the extremity in the position found to reduce pain, prevent further injury, and facilitate safe transport to medical care 1
• If the injured hand is blue, purple, or extremely pale, activate emergency medical services immediately, as this indicates vascular compromise requiring urgent intervention 1, 2
• Cover any open wounds with a clean dressing before applying the splint to reduce contamination risk 1, 3

Critical Timing Considerations

The American Heart Association and American Red Cross guidelines emphasize that splinting is a temporary first aid measure, not definitive treatment 1. The patient needs prompt medical evaluation because:

• Definitive assessment should occur within 1-2 days to determine if the fracture requires operative intervention, closed reduction, or conservative management 4, 5
• Radiographic evaluation is essential to measure the degree of angulation and metacarpal shortening, which determines treatment approach 6, 5, 7
• Fractures with >40° angulation at the neck or >25° in the diaphysis typically require more aggressive management than simple splinting 7

Avoiding Common Pitfalls

• Do not leave the patient in a rigid splint for weeks without specialist evaluation 2, 8
• Prolonged immobilization beyond what is necessary leads to joint stiffness that is functionally disabling and difficult to treat after healing 2, 8
• The initial splint is for protection and pain control only until proper treatment can be initiated 1

Definitive Treatment Pathway

Once evaluated by a healthcare provider:

• Functional bracing or taping allows earlier return to function compared to rigid cast immobilization and is the preferred conservative approach for appropriate fractures 4, 9
• Operative fixation may be indicated for severe angulation, rotational deformity, or in patients requiring early return to work 6, 5
• Conservative treatment typically involves 3-4 weeks of immobilization followed by mobilization exercises 4, 7