Splinting Technique for Fractures of the Base of Metacarpals 2 and 3
Apply a radial gutter splint extending from the proximal forearm to just beyond the fingertips of the 2nd and 3rd digits, maintaining the MCP joints in 70-90 degrees of flexion and the IP joints in slight flexion, while immediately beginning active motion exercises for all uninjured fingers. 1
Immediate Assessment Before Splinting
- Check for vascular compromise immediately: If the extremity is blue, purple, or pale, activate emergency medical services without delay, as this indicates limb-threatening poor perfusion 2, 1
- Obtain three-view radiographs (PA, lateral, and oblique) to detect displacement, angulation, and articular involvement before splinting 1, 3
- If severe bleeding is present, control hemorrhage first before addressing the fracture 2
- Cover any open wounds with a clean dressing before splinting to reduce contamination and infection risk 2, 1
Splinting Technique and Positioning
For base of metacarpal 2 and 3 fractures, use a radial gutter splint (analogous to the ulnar gutter technique used for 4th and 5th metacarpals but applied to the radial side of the hand) 1:
- Extend the splint from the proximal forearm to just beyond the fingertips of the 2nd and 3rd digits 1
- Position the hand in the "safe position" with MCP joints flexed 70-90 degrees and IP joints in slight flexion 1
- Ensure adequate padding and comfortable tightness without constricting circulation 1
- Splint the fracture in the position found unless straightening is necessary to facilitate safe transport 2, 1
A hand-based functional splint is an excellent alternative that allows wrist and uninjured digit motion while maintaining fracture stability 4:
- This approach permits MCP, IP, and radiocarpal joint motion in uninjured fingers 4
- Functional splinting maintains excellent fracture reduction while allowing immediate return to activities 4
- Average splint duration is approximately 24 days with this approach 4
Critical Early Motion Protocol
Begin active finger motion exercises immediately for all uninjured fingers from the first encounter 1, 3:
- Finger motion does not adversely affect adequately stabilized fractures 1, 3
- Finger stiffness is one of the most functionally disabling complications following hand fractures and can require multiple therapy visits or even surgical intervention if it develops 1, 3
- Instruct patients to move all uninjured fingers regularly through complete range of motion 1
- Early mobilization is critical to prevent stiffness and restore function 5, 6
Duration and Follow-Up
- Continue rigid or functional splinting for 3-4 weeks 1, 3
- Obtain radiographic follow-up at approximately 3 weeks to assess healing 1, 3
- When immobilization is discontinued, transition to aggressive finger and hand motion exercises 3
Common Pitfalls to Avoid
Do not over-immobilize: Prolonged immobilization beyond what is necessary causes joint stiffness that is difficult to reverse and may require extensive therapy 1, 3, 7:
- Avoid rigid splinting when functional splinting would suffice 1
- Never immobilize uninjured fingers—this is a critical error 1
Ensure adequate initial imaging: Two views are insufficient; always obtain three views including oblique projections to avoid missing displacement or articular involvement 1, 3
Monitor for complications: Functional casting reduces volar angulation significantly compared to traditional immobilization and reduces sick leave by two-thirds 8