How do I ... splint a 1st metacarpal fracture?

Too often I hear from First Encounter Providers (FEP) that “I don’t have the supplies” or “I’m not comfortable splinting” as reasons for not placing a patient in a non-removable splint (fiberglass or plaster). With so many other areas of medicine, we do all that we can possibly do within our scope and ability based on practice setting to provide the best medical care for patients - why is orthopedics different?

Physicians, Nurse Practitioners, and Physician Associates (previously Physician Assistants) provide upstanding care for patients around the world in ER, Acute Care/Urgent Care, Family Medicine and Occupational Medicine clinics. It’s been well documented that ⅓ of all visits in these areas of medicine are musculoskeletal. They are the most likely ones to have the 1st encounter with musculoskeletal injuries!

EVERY INJURY of the hand and wrist must get xrays upon initial evaluation. It does not matter the mechanism or clinical appearance. Consider xrays as PART OF THE EXAM! 💡

A velcro thumb spica wrist splint from the home medical store (durable medical equipment) is an option for:

1. Thumb pain with normal xrays
2. Non-displaced to minimally displaced fracture of the thumb metacarpal or proximal phalanx
3. Snuffbox pain with normal xrays

A thumb spica non-removable splint (check out this video) is appropriate for:

1. Displaced/unstable fracture of thumb metacarpal (1st metacarpal) or proximal phalanx
2. Scaphoid fracture seen on xray (though some research shows you do not need to include the thumb in the splint 🤔)
3. Radial styloid distal radius fracture

Once you get the xray, have the patient go back to an exam room while you take a look at the films. You may not have all the words to describe the fracture, but as you look more and more at hand and wrist radiographs, you will become familiar with Thumb IP and MCP joint alignment, sesamoid bones, Thumb CMC joint, STT (scaphoid-trapezium-trapezoid) joint, the normal appearance of Scaphoid with its tubercle and alignment within the Scaphoid fossa of the distal radius!

(Helpful hint to remember one of the carpal bones: “Base of thumb, Trapezium!” 👍)

🔥 By looking at the xrays and placing them in a splint, you will be able to provide the best possible care for your patient rather than sending them home with an injury but without a splint! 

This video walks you step by step how to apply a Thumb Spica Splint for a thumb metacarpal fracture.

You can also download a PDF Splinting Guide to use as a reference!

To your success in providing exceptional orthopedic care for patients!

- Vanessa