Post-Surgical Immobilization for Fifth Metacarpal Head Fracture
After surgical fixation of a displaced and angulated fifth metacarpal head fracture in a young to middle-aged adult, use a rigid cast or splint that immobilizes the fracture while allowing finger motion, rather than a removable splint.
Rationale for Rigid Immobilization
The evidence strongly supports rigid immobilization over removable splints for displaced metacarpal fractures:
- Rigid immobilization (casting) is preferred over removable splints for displaced fractures, as recommended by the American Academy of Orthopaedic Surgeons 1
- The cast should immobilize the fracture site while specifically allowing for finger motion to prevent stiffness 1
- Removable splints are only appropriate for minimally displaced fractures, not for the displaced and angulated fractures requiring surgical fixation 1, 2
Specific Immobilization Technique
For post-surgical management of fifth metacarpal head fractures:
- A combination of malleable aluminum alloy splint and plaster of Paris cast has demonstrated significant improvement in maintaining fracture alignment at 3-5 week follow-up with no complications 3
- The splint should be padded to cushion the injury 4
- Do not attempt to straighten or realign the fracture further—splint in the position achieved surgically 4
Critical Mobilization Strategy
Active finger motion exercises should be performed immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling complications 2:
- Finger motion does not adversely affect adequately stabilized fractures in terms of reduction or healing 2
- The metacarpophalangeal (MCP) joint should maintain range of motion during immobilization 5
- Prolonged rigid immobilization beyond what is necessary leads to joint stiffness, which is functionally disabling and difficult to treat after healing 4
Duration and Follow-Up
- Maintain immobilization for approximately 3 weeks with radiographic follow-up 1, 2
- Average healing time for surgically fixed fifth metacarpal fractures is 5.7±1.09 weeks (range 5-10 weeks) 5
- Repeat radiographic evaluation at cessation of immobilization 1
Common Pitfalls to Avoid
- Do not use removable splints for displaced fractures requiring surgical fixation—these are only appropriate for minimally displaced fractures 1, 2
- Avoid excessive immobilization duration that restricts finger motion unnecessarily 4
- Monitor for vascular compromise—if the extremity becomes blue or extremely pale, this represents a medical emergency 4