Metacarpal Fractures: Surgery vs. Cast Treatment Options

Metacarpal fracture

Hello, I would like to ask some questions.
At the beginning of February, I had an accident that resulted in a closed fracture of the fourth metacarpal, near the phalanx.
The X-ray showed displacement and misalignment, and the examining physician assessed it as a fracture since it was not as closely aligned as the other metacarpals.
Initially, the doctor evaluated that surgery was not necessary, and that I only needed a splint for immobilization.
However, after a month, a follow-up X-ray showed that the displaced portion still existed, but there were signs of slight healing.
A friend once asked me why I didn't opt for surgery, suggesting it might heal faster.
Since I didn't understand at the time, I didn't think much of it.
Now, I'm reconsidering the possibility of surgery, so I would like to ask if it would be advisable to decide on surgery now.
Would it lead to a faster recovery, or should I continue with the splint? How long would it take before I can return to my usual activities? Thank you.

Niming, 20~29 year old female. Ask Date: 2017/03/15

Dr. Shi Guozheng reply Orthopedics

If the displacement is not severe, surgery may not be necessary.
A metacarpal fracture can heal in about a month, and full recovery of function typically takes around three months, with an additional two to four weeks for complete healing.

Reply Date: 2017/03/15

More Info

Understanding metacarpal fractures, particularly in the context of your situation, involves a careful consideration of the fracture type, the degree of displacement, and the healing process. Metacarpal fractures are common injuries, often resulting from trauma, such as falls or direct blows to the hand. The treatment options typically include conservative management with casting or surgical intervention, depending on the specifics of the fracture.

In your case, you have a closed fracture of the fourth metacarpal with some degree of displacement. Initially, your physician recommended conservative treatment with a cast, which is a common approach for non-displaced or minimally displaced fractures. The rationale behind this decision is that many metacarpal fractures can heal effectively without surgery, especially if the fracture is stable and the alignment is acceptable.

However, after a month of treatment, the X-ray indicated that the fracture remains displaced, albeit with some signs of healing. This situation raises important considerations. If a fracture is significantly displaced, it may not heal properly, potentially leading to functional impairments, such as reduced grip strength or limited range of motion. Surgical intervention, typically involving internal fixation with plates or screws, can realign the bones and stabilize the fracture, promoting more optimal healing.

The decision to proceed with surgery at this stage depends on several factors:
1. Degree of Displacement: If the fracture is still significantly misaligned, surgery may be warranted to restore proper anatomy.

2. Functional Impairment: If you are experiencing pain, difficulty in movement, or concerns about the long-term function of your hand, surgical intervention might be beneficial.

3. Healing Progress: The presence of some healing does not necessarily mean that the fracture is healing correctly. If the alignment is poor, surgery may still be necessary to ensure proper function in the long term.

4. Timing: While it is often ideal to address significant displacements early, surgery can still be performed later if necessary. However, the longer you wait, the more challenging it may become to correct the alignment, and the risk of complications, such as stiffness or chronic pain, may increase.

5. Consultation with a Specialist: It is advisable to discuss your concerns with an orthopedic surgeon who specializes in hand injuries. They can provide a thorough evaluation and help you weigh the risks and benefits of surgery versus continued conservative treatment.

Regarding recovery, if you opt for surgery, the healing time may vary. Generally, after surgical fixation, you might expect a recovery period of 6 to 8 weeks before you can resume normal activities, but this can vary based on individual healing rates and adherence to rehabilitation protocols. If you continue with casting, the healing process may take longer, especially if the fracture remains misaligned.

In conclusion, while surgery can potentially lead to faster and more reliable healing for displaced metacarpal fractures, the decision should be made based on a comprehensive evaluation of your specific situation. Engaging in a detailed discussion with your healthcare provider will help you make an informed choice that aligns with your recovery goals and lifestyle.

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