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  3. Diagnosis
  4. Indications
  5. Treatment

Authors of section

Authors

Fabio A Suarez, Aida Garcia

Executive Editor

Simon Lambert

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Nonoperative treatment

1. General considerations

Indications

Stable, nondisplaced fractures of the metacarpals can be treated nonoperatively with controlled movement by buddy strapping and restricted extension with a dorsal splint.

Nonoperative treatment with splinting for undisplaced or minimally displaced diaphyseal and stable proximal extraarticular metacarpal fractures

Dorsal splinting

Apply a dorsal splint in a hand protection position. This splint is easy to apply and there is no hand therapy needed.

In the first week, a palmar protection splint should be added.

The dorsal splint allows immediate active mobilization (flexion) of the finger joints and help with pain and edema control.

Hand position for splinting

The hand is splinted in an intrinsic plus (Edinburgh) position:

  • Neutral wrist position or up to 15° extension
  • Metacarpophalangeal (MCP) joint in 90° flexion
  • Proximal interphalangeal (PIP) joint in extension
The hand in the intrinsic plus or Edinburgh position for splinting

The reason for splinting the MCP joint in flexion is to maintain its collateral ligament at maximal length, avoiding scar contraction.

PIP joint extension in this position also maintains the length of the volar plate.

The metacarpophalangeal joint in flexion maintains the collateral ligament at maximal length and the proximal interphalangeal in extension maintains the length of the volar plate.

AO teaching video

Phalanx–Proximal Fractures–Extension Block Splint (Burke Halter)

2. Buddy strapping

Strap the injured finger to a neighboring finger.

The strapping should leave the joints free for mobilization.

Direct skin contact with adjacent fingers should be prevented by placing gauze pads between them.

Buddy strapping avoiding direct skin contact with adjacent fingers as conservative treatment

3. Splint application

Protect the skin of the arm and hand with padding/cotton sleeve to avoid pressure sores, especially on the distal ulna and styloid process of the radius.

Application of a padding sleeve to protect the skin

In compliant patients, only the affected and the directly neighboring fingers may be included in the splint.

Create a splint of at least 6 slabs of cast bandage. It should cover the dorsal or palmar half of the forearm, wrist, and hand.

The wrist should be in neutral or up to 15° extension.

Splint of at least 6 cast bandage slabs applied in 15° extension covers the dorsal half of the forearm, wrist, and hand.

The splint is held in place with an elastic bandage. The bandage should not be overtightened at the level of the wrist joint to avoid excessive swelling of the hand.

Direct skin contact with adjacent fingers should be prevented by placing gauze pads between them.

The splint is held in place with an elastic bandage.

4. Aftercare

Postoperative phases

The aftercare can be divided into four phases of healing:

  • Inflammatory phase (week 1–3)
  • Early repair phase (week 4–6)
  • Late repair and early tissue remodeling phase (week 7–12)
  • Remodeling and reintegration phase (week 13 onwards)

Full details on each phase can be found here.

Follow-up

X-ray checks of fracture position should be performed immediately after the splint has been applied.

Follow-up x-rays with the splint should be taken after 1 week and after 2 weeks if there is doubt about maintenance of reduction.

Splinting is continued until about 4 weeks after the injury. At that time, an x-ray without the splint is taken to confirm healing, and range of motion should be pain-free.

Mobilization

Splinting can then usually be discontinued, and active mobilization is initiated. Functional exercises are recommended.

If, after 8 weeks, x-rays confirm healing, full manual loading can be permitted.

Functional exercises for hand and fingers