Metacarpal fractures

Management depends on whether the fracture is open (has a wound over it) or closed, whether it goes into the joint or not, and then on the displacement. If open, it requires a thorough debridement and irrigation to clean it, and then mostly some form of fixation is used, depending on the fracture morphology and location. Open injuries may have associated nerve, vessel, tendon or joint injury.

If closed and within the joint, and there is significant displacement, the patient requires an open reduction and fixation of the joint.

If closed and outside the joint, the management is decided upon according to deformity and displacement.

If non-operative management is required, it involves immobilising the hand in a splint, usually for 3-4 weeks before range of motion exercises can be begun.

Phalangeal fractures

Phalangeal fracture management is similarly determined by whether open or closed, intra or extraarticular (within the joint or outside the joint) and then on the degree of displacement

If open, it is treated with the same principles as for a metacarpal fracture and then mostly with subsequent fixation, either using a wire or screws and a plate if necessary.

If closed and intraarticular, again, it usually requires and open reduction and fixation to restore the joint to normal function.

If closed and extraarticular, the management is decided on by the degree of deformity and displacement.

For non-operative management, the hand and fingers may need to both be splinted, or simply the individual finger splinted, depending on fracture characteristics.