Radiographic Outcomes of Casting Versus Splinting for Conservatively Treated Metacarpal Fractures

Introduction While many have studied alternate forms of casting for conservative treatment of metacarpal fracture, few have compared casting and splinting. This study aims to compare radiographic alignment in metacarpal shaft and neck fractures immobilized with splints to those treated with casts. Methods A retrospective review was conducted to identify all metacarpal fractures treated by a single orthopedic hand surgeon from 2016-2020. Patients with metacarpal shaft or neck fractures treated nonoperatively, immobilized with either a cast or a splint, and with a minimum of one follow-up visit were included. Degrees of radial/ulnar angulation, dorsal/volar angulation, and changes in angulation were measured. Mean angulation measurements and changes in angulation were compared across groups using Mann-Whitney U tests. Results A total of 61 patients, 45 treated with casts and 16 with splints, met our inclusion criteria. The average immobilization time was 28 days for both groups (p=0.958). Change in radial/ulnar angulation was similar between the two groups (splint = -3⁰, cast = -3⁰, p=0.79). No significant differences were found when comparing changes in dorsal/volar angulation across groups (splint = -0.3⁰, cast = -0.1⁰, p=0.57). No complications were reported in either group. Conclusions Our results suggest that metacarpal shaft and neck fractures treated with splints can maintain fracture reduction and angulation comparable to casting. Splints offer additional benefits of reduced costs with improved patient hygiene and satisfaction. Further studies on the utility and cost-effectiveness of splints for treating metacarpal fractures are warranted.