Best Immobilization for Base of 5th Metacarpal Fracture
For non-displaced or minimally displaced fractures of the base of the 5th metacarpal, functional taping or buddy strapping with a Futura splint is superior to rigid cast immobilization, allowing earlier return to function while maintaining acceptable alignment.
Immobilization Strategy
Primary Recommendation: Functional Immobilization
- Functional taping or buddy strapping provides significantly faster functional recovery compared to rigid plaster casting 1
- The splint should immobilize the fracture site while allowing finger motion to prevent stiffness 2
- Buddy strapping with a Futura splint provides good functional results for closed, non-displaced fractures without significant angulation 3
Key Advantages of Functional Taping
- Patients treated with functional tape demonstrate significantly earlier functional recovery at 1 week and 4 weeks compared to ulnar gutter plaster casts 1
- Sick leave is reduced by two-thirds with functional casting compared to rigid plaster immobilization 4
- At 6 months, functional and anatomical outcomes are equivalent between functional taping and rigid casting 1
Clinical Decision Algorithm
When Conservative Treatment is Appropriate:
- Closed fractures 3
- Non-displaced or minimally displaced fractures 3
- No malrotation 3
- Acceptable angulation (most studies accept up to 70 degrees for conservative management) 3
When Surgical Fixation is Indicated:
- Open fractures 3
- Significant displacement (>3mm) 2
- Malrotation present 3
- Neurovascular injury 3
- Intra-articular fractures with inadequate closed reduction 5
Important Caveats
Fracture Stability Considerations
- Base of 5th metacarpal fractures are inherently unstable, and inadequate reduction may result in pain, functional disability, and osteoarthritic changes 5
- For intra-articular or comminuted fractures at the base, reduction with restoration of the articular surface and pinning is the method of choice 5
- Change in fracture angulation occurs only in fractures that had been initially reduced, regardless of immobilization method 1
Radiographic Follow-up
- Standard 3-view radiographic examination should be performed to confirm proper alignment before and after splint application 2
- Radiographic follow-up is recommended at approximately 3 weeks to confirm adequate healing 2
Rehabilitation Protocol
- Active finger motion exercises should be performed following diagnosis to prevent stiffness 2
- Finger motion does not adversely affect adequately stabilized metacarpal fractures 2
- Functional casting allows the wrist and digits a free range of motion, reducing restriction of joint movements 4
Special Population Considerations
For office workers or patients with high functional demands requiring early return to work, minimally invasive K-wire fixation may be considered even for fractures that would typically be managed conservatively, as this allows return to work in approximately 4 days versus 34 days with conservative treatment 6