Questions about the treatment of the fractures around the fifth metacarpophalangeal joint

Abstract

The little finger, more than other fingers, may display a tendency to ‘curl’ after trauma or operation with a contracted hyperextension of the MCP joint and flexion of the interphalangeal joints. Although in my country the teaching is that you should immobilize the finger in the intrinsic plus position to avoid this problem, I believe that this is over-advised and over-used. I have encountered very few cases with contracture after longstanding immobilization, and I challenge the dogma that casting the fingers in the intrinsic plus position is mandatory. I consider the concept of safe-position as one among many examples of theoretical biomechanical considerations that lack clinical verification (Tang, 2019). My experience is that if immobilization in extrinsic plus is attempted, the hand almost always spontaneously slides into a more comfortable position with less MCP joint flexion in the plaster cast. For me, the key point is mobilization of the fingers before fracture healing is achieved and ensuring that the exercises are properly executed. In treating hand disorders, I use immobilization in a near ‘safe’ position in only a few situations, for example moderate MCP joint flexion of 40 –60 after flexor tendon reconstruction in the fingers. However, again as far as possible, I start with immediate or at least very early mobilization.