Subcapital Fractures of the Fourth and Fifth Metacarpals Treated Without Splinting and Reposition

Abstract

The aim of the study was to evaluate the results after treating subcapital fractures in the fourth and fifth metacarpals with immediate mobilisation and without splinting or reduction. We undertook a prospective clinical evaluation of 36 subcapital fractures of the fourth and fifth metacarpals treated with immediate mobilisation and without splinting or reduction during the period 1 January 1990 to 31 December 1992 in the accident and emergency department, Holstebro Central Hospital. After 4 weeks only 4 patients (11%) had restricted movement in the metacarpophalangeal joint (less than 0-80 degrees of movement). The fracture had healed in 33 patients (92%), and 31 of the patients (86%) were completely satisfied. We conclude that subcapital fractures in the fourth and fifth metacarpals can be treated without immobilisation or reposition.

Principles of Metacarpal and Phalangeal Fracture Management: A Review of Rehabilitation Concepts

“…Debate continues over the necessity to reduce and immobilize these fractures. 3,14,56 However, angulated neck fractures that heal with volar displacement over 30°place the intrinsic muscle in a shortened position, which reduces the muscle's excursion capacity. This loss of full muscle length results in limited ability to initiate flexion at the MP joint.…”

“…Because the FDP tendons blend into 1 multistrand tendon inserting into the muscle belly, blocking 1 tendon's excursion effectively blocks all others. 14 The only motor that is now free to glide and flex the PIP joint is the FDS tendon. The ''sublimis fist'' ( Figure 2F) maximally glides the FDS tendon past the FDP tendon with full MP and PIP flexion and an extended DIP joint.…”

Outcome of Boxer's Fractures Treated by a Soft Wrap and Buddy Taping: A Prospective Study

“…Twenty-four patients (96%) were asymptomatic at final evaluation. Because patients with a boxer's fracture are frequently known to be noncompliant [4,7,22,34], it is doubtful that they closely followed the treatment protocol, although all patients presented with the wrap and buddy taping. One might argue that no treatment could be a treatment option as well.…”

“…The initial pain relief with the use of braces as compared to functional taping [15,31] did not influence the length of time off from work. However, because of the compliance issue, we prefer to avoid bracing because of the risk of skin necrosis over the metacarpal [7,13,17,29] and as well the need to control the brace on a regular basis. The patients themselves prefer buddy taping to casting and no follow-up evaluations [2].…”

“…Overall results are generally satisfactory. Follow-up is often difficult because of poor compliance [7,22], and therefore, a simple, low-cost, and limited labor-intensive treatment would be ideal. At the University Hospital of Geneva, we commonly treat a boxer's fracture with a selfadherent wrap covering metacarpal bones II-V and buddy taping of the ring and little fingers for a period of 3 weeks while allowing immediate free range of motion (ROM).…”