Metacarpal and Phalangeal Fractures
Nondisplaced metacarpal fractures are stable injuries and are treated with application of an anterior-posterior splint in the position of function: the wrist in 30 to 60 degrees of extension, the MCP joints in 70 degrees of flexion, and the IP joints in 0 to 10 degrees of flexion. In this position, the important ligaments of the wrist and hand are maintained in maximal tension to prevent contractures (Fig. 1–25).

Allowing early PIP and DIP joint motion is essential. Motion prevents adhesions between the tendons and the underlying fracture and controls edema. The dorsal fiberglass splint should extend from below the elbow to the fingertips of all the involved digits and one adjacent digit. The anterior splint should extend from below the elbow to the distal aspect of the proximal phalanx (Fig. 1–26A), allowing the patient to resume PIP and DIP joint active flexion and extension exercises immediately (see Fig. 1–26B).

Comminuted phalangeal fractures, especially those that involve diaphyseal segments with thick cortices, may be slow to heal and may require fixation for up to 6 weeks (Fig. 1–27).