Do 5th metacarpal fractures need cast immobilization?
By: Janelle Freshman, PT DPT CHT OCS
A recent study published in the Journal of Hand Surgery in December 2020 investigated the results of two methods of treating 5th metacarpal neck fractures with less than 70° volar angulation without rotational deformity:
1. Traditional treatment- closed reduction and cast immobilization in the safe position: MCP flexion and PIP/DIP joint extension.
2. Buddy taping the small finger to ring finger without immobilization or closed reduction.
The authors note traditional treatment does not seem to change final position of the fracture; however, it does reduce pain and ensure maintenance of the fingers in the safe position. Despite this, the traditional treatment may slow functional recovery- including return to work timeline.
A prospective randomized trial was conducted to compare the functional results of 72 patients who underwent one of the following:
A) Buddy taping for 3 weeks
B) Closed reduction and immobilization in the safe position- both PIP and wrist included- for 3 wks.
Conclusion: While both treatment methods resulted in good outcomes, simple buddy taping with immediate mobilization resulted in better results at 3 week and 9 week follow up in comparison to traditional treatment- including shortened return to work time and reduced complication rate- i.e. joint stiffness. Nine patients treated with closed reduction and casting and 2 patients with buddy taping experienced complications with MCP/ PIP joint stiffness. Hand therapy attendance by those with stiffness was not reported by the authors. Additionally, fracture reduction was not found to change the final position of the fracture, and immobilization was not deemed necessary to hold a reduction and ensure healing.
Thus, based on this study, it appears patients treated with buddy taping will:
• Likely will not need hand therapy services
• Experience a quicker return of mobility and function compared to closed reduction and immobilization, including on average 28 days quicker return to work
• Experience smaller complication rates
What are your thoughts?
References:
A Prospective Randomized Trial Comparing the Functional Results of Buddy Taping Versus Closed Reduction and Cast Immobilization in Patients With Fifth Metacarpal Neck Fractures. J Hand Surg Am. 2020;45(12):1134-1140.