Treatment of Fifth Metacarpal Fractures

Splint Type Selection

The American College of Surgeons recommends that the splint should be padded and comfortably tight but not constrictive, allowing a finger to slip underneath 1

The American Academy of Orthopaedic Surgeons recommends immobilizing the fracture for 3-4 weeks with radiographic follow-up at approximately 3 weeks and at cessation of immobilization 1
Obtain radiographic follow-up at 3 weeks to assess healing and alignment 1
Final radiographic assessment should occur when immobilization is discontinued 1

The American College of Emergency Physicians recommends beginning active finger motion exercises immediately for all unaffected joints to prevent finger stiffness 1, 2
Active motion does not adversely affect adequately stabilized fractures 1, 3
Finger stiffness can be extremely difficult to treat after healing, potentially requiring multiple therapy visits and surgical intervention 1, 2
Transition to aggressive finger and hand motion exercises when immobilization is discontinued 1

The American Heart Association recommends splinting the fracture in the position found unless straightening is necessary to facilitate safe transport 4, 5
Do not attempt to straighten angulated fractures in the first aid setting, as this may cause further injury 2
Cover any open wounds with a clean dressing to reduce contamination risk 4, 5

The American College of Surgeons recommends activating emergency services immediately if the fractured extremity is blue, purple, or pale, as this indicates poor perfusion and represents a limb-threatening injury 4, 5

Over-immobilization: Rigid splinting when functional splinting would suffice leads to unnecessary stiffness and prolonged disability 1, 2
Prolonged immobilization beyond 4 weeks: This increases joint stiffness requiring additional therapy without providing additional benefit 3, 2
Immobilizing unaffected fingers: This dramatically increases the risk of hand stiffness and functional impairment 1
Inadequate radiographic follow-up: Failure to obtain 3-week radiographs may miss loss of reduction requiring intervention 1