Management of Spiral Fracture of the 5th Metacarpal

Diagnostic Imaging

CT imaging is typically not indicated unless there is concern for complex articular involvement, as recommended by the American College of Radiology 1

Active finger motion exercises should be initiated immediately following diagnosis and treatment to prevent stiffness, as recommended by the American Academy of Orthopaedic Surgeons 2
Wrist motion does not need to be started early following stable fracture fixation, according to the American Academy of Orthopaedic Surgeons 2
When external fixation is used, limiting the duration of fixation is recommended to reduce complications, as suggested by the American Academy of Orthopaedic Surgeons 2
Consider vitamin C supplementation for prevention of disproportionate pain, as recommended by the American Academy of Orthopaedic Surgeons 2

Finger stiffness is the most common functionally disabling complication, as reported by the American Academy of Orthopaedic Surgeons 2

Standard radiographic examination should include at least 3 views (posteroanterior, lateral, and 45° semipronated oblique) to properly visualize metacarpal fractures, as recommended by the American College of Radiology 3
An internally rotated oblique projection, in addition to the standard externally rotated oblique, increases diagnostic yield for metacarpal fractures, according to the American College of Radiology 3
CT imaging is usually not indicated for metacarpal fractures during acute injury unless there is concern for complex articular involvement, as stated by the American College of Radiology 4