Reduction of angulated metacarpal fractures with a custom fracture-brace

A thermoplastic fracture-brace was compared to closed reduction with ulnar gutter splinting in the treatment of 38 isolated fractures of the fifth metacarpal with angulation more than 40 degrees at the neck or 25 degrees in the diaphysis. Patient profiles, fracture patterns, compliance rates, and time to clinical union were similar in the two treatment groups. The two treatment methods improved fracture angulation by the same amount, to about one half of the initial angulation. At the time of splint or brace removal, there was more restriction of wrist, metacarpophalangeal, and proximal interphalangeal motion in the closed reduction/ulnar splint group, but this difference resolved by 3 months following injury. Serious skin problems were not encountered in either treatment group. Problems with fracture reduction occurred in two cases from each group; all involved oblique fractures. In laborers, the fracture-brace did not offer enough hand protection to allow them to resume heavy work before fracture union. The fracture-brace corrected fracture angulation as effectively as closed reduction with gutter splinting, and it restored motion to the fractured hand more quickly.