Initial Treatment of Closed Metacarpal Fractures

Abstract

A prospective clinical trial compared two forms of initial management for closed stable fractures of the shaft of the finger metacarpals. Patients were randomized to treatment with a compression glove and early mobilization (21 patients) or to immobilization in a plaster splint (21 patients). The mean loss of total active flexion (MP+PIP+DIP) in the second week after injury was 56 degrees in the glove group and 84 degrees in the splint group (P = 0.0036). In the third week, the mean loss of flexion was 23 degrees and 46 degrees respectively (P = 0.0010). Hand volume and PIP joint circumference were significantly smaller in the glove group in the second week but not in the third and fourth weeks. Within each group, however, there was no correlation between range of motion and swelling, suggesting that these were independent variables in this study. The support of the glove helped to relieve pain. Use of a compression glove avoided the loss of function imposed by splintage and was associated with a greater range of movement during the second and third weeks.