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The Metacarpal Mitt Splint for 2nd-5th Metacarpal Fractures: A Prospective Case Series
Daniel Yang Hong, MD, Chimere O Ezuma, BA, Peter C Noback, MD, Liana J Tedesco, MD and Robert J Strauch, MD, Columbia University Medical Center, New York, NY

Introduction
Metacarpal fractures are common; metacarpal fractures of the index, long, ring, and small fingers account for the majority. Traditionally, these fractures are treated nonoperatively. We propose utilizing a "metacarpal mitt", a novel splint compromised of plaster of Paris around the palm of the hand (Figure 1). The advantages of the metacarpal mitt would be that the wrist, PIP, and DIP joints are left free while still immobilizing the metacarpals. We hypothesize that these patients would have good clinical outcomes with non-operative management of 2nd-5th metacarpal fractures using the metacarpal mitt.

Methods
In this prospective case series, patients were identified after work-up demonstrated a 2nd-5th metacarpal fracture and enrolled after follow-up at three weeks post-injury. Exclusion criteria were age < 18, lack of follow-up, fracture of the first metacarpal, open fracture, and multiple fractures. Informed consent was obtained. Patient data were collected via chart review. Quick DASH scores were obtained at two months post-injury.

Results
Thirteen patients met inclusion criteria. Ten patients (77%) were male, nine fractures (69%) occurred in the right hand, and majority of the small finger (nine small finger, three ring finger, one long finger). Median follow-up was 2 months (range 1 to 9 months). Median radiographic parameters at injury (5 degrees coronal, 20 degrees sagittal, 0 mm shortening) were similar to that at follow-up (7 degrees coronal, 20 degrees sagittal, 1 mm shortening). Median clinical malrotation and extensor lag at injury (0, 0 degrees respectively) were similar to that at follow-up (0, 0 degrees respectively). (Figure 2) At follow-up, only 4 patients had decreased range of motion in various joints (4 at the MCP joint and 1 at the PIP joint). All patients had diminished pain from injury to follow-up. 8 patients met criteria and were successfully contacted for Quick DASH scores. Median Quick DASH score was 1.2. No patients required operative intervention.

Conclusions
The metacarpal mitt is a novel splint that can be used to treat 2nd-5th metacarpal fractures. All patients were treated non-operatively successfully without loss of reduction and improved pain and functional scores at follow-up. Further prospective comparative studies are indicated.


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