From the Guidelines
A displaced oblique fracture of the third metacarpal shaft typically requires prompt orthopedic intervention to prevent long-term functional deficits. The initial management includes immobilization with a forearm-based splint, elevation of the hand above heart level, and pain control with acetaminophen 650mg every 6 hours and/or ibuprofen 400-600mg every 6 hours as needed. Ice should be applied for 15-20 minutes every 2-3 hours for the first 48 hours to reduce swelling.
Key Considerations
- Most displaced metacarpal fractures require reduction and fixation, either with closed reduction and percutaneous pinning or open reduction and internal fixation (ORIF) with plates and screws, especially if there is rotational deformity or significant displacement.
- The treatment approach for distal radius fractures, as suggested by 1, may not be directly applicable to metacarpal fractures, but the principle of addressing displacement and angulation to prevent long-term functional deficits is relevant.
- Following surgical intervention, a short-arm cast or splint is typically maintained for 4-6 weeks, followed by physical therapy to restore hand function and grip strength.
Treatment Goals
- Prevent long-term functional deficits such as decreased grip strength, malrotation of the finger, or knuckle deformity.
- Restore hand stability and proper alignment of the third metacarpal.
- Minimize pain and discomfort during the recovery period. The specific treatment approach for a displaced oblique fracture of the third metacarpal shaft should be individualized based on the patient's overall health, the severity of the fracture, and the presence of any associated injuries or conditions.
From the Research
Displaced Oblique Fracture of Third Metacarpal Shaft
- A displaced oblique fracture of the third metacarpal shaft is a type of metacarpal fracture, which comprises between 18-44% of all hand fractures 2.
- Non-thumb metacarpals, including the third metacarpal, account for around 88% of all metacarpal fractures 2.
- The treatment of metacarpal fractures, including displaced oblique fractures of the third metacarpal shaft, can be challenging due to the lack of high-level evidence to guide fracture management 3.
- Various treatment options are available for metacarpal fractures, including:
- Splinting
- Percutaneous fixation
- Open reduction with internal fixation
- External fixation
- All these modalities are acceptable strategies for treating metacarpal fractures, with the ultimate goal of maximizing hand function with minimal morbidity 3.
- The choice of treatment depends on the specific characteristics of the fracture, including the location, displacement, and stability of the fracture, as well as the patient's overall health and functional goals 3.