10 year old has a fractured 3rd metacarpal

[rstewy]

My nephew fractured his 3rd metacarpal but the fracture is nondisplaced. There is a less than 20 degree angulation (from her notes) and no reduction was required because his hand functions great and ROM was not reduced. He didn't see the ortho until 2 weeks after the injury and she said she would cast it for 3 weeks and brace it for 3 weeks. I said that was great because he had a hockey tryout in 6 weeks. That bothered the ortho and she changed the treatment to 6 weeks casting and 4 weeks bracing. She also gave no consideration for the two weeks it was braced prior to seeing her. She gave no reason for the change except to imply hockey wasn't worth it. That means she is immobilizing the hand for 12 weeks total and my question is does that sound reasonable? The boy is devasted as hockey is his life and he takes it serious. His team was the ontario AAA champs this year and if he has to sit out a year because of this he will lose the most important thing in his life. I'm not advocating putting him at risk but I don't understand why she changed the treatment without a reason. It sounds like and awfully long time for what she described as a minor fracture. What do you think?

[mtomaino]

Thanks for your post. First, it's difficult to weigh in on this without seeing the x-ray or knowing how old your nephew is. That having been said, a metacarpal bone should heal within 6 weeks, and in many cases, I would be able to treat in a "plastic" brace which would allow at least some motion of the fingers to prevent stiffness.

Given the importance of hockey, I would think that return to play might be possible once "healing" has been established. Another consideration is for fracture fixation with a plate and screws-------this might expedite healing and certainly would obviate the need for prolonged immobilization. This probably is not something I'd routinely recommend in a child, but this type of more aggressive intervention becomes an option in older athletes who can't afford a prolonged recovery.

If you are able to attach some pics of the x-rays, I'd be happy to look at them.

[mtomaino]

I have reattached the AP and Lateral x-rays which show, as you indicated in your initial post, a distal nondisplaced fracture of the long finger metacarpal, just proximal to the MP joint. The lateral x-ray shows about 20 degrees of apex dorsal angulation. This angulation explains why the length of the long finger metacarpal is a bit shortened on the AP x-ray.

If I am correct--- and your nephew is about 10 years old----nonoperative treatment is likely to result in an excellent functional result. I would anticipate that this would be healed within 4-6 weeks of injury.

So if the injury occurred 2 weeks before the x-rays that you attached (dated mid march), it's now been about 4 weeks. If the bone is nontender on palpation at this time, it's pretty likely that the fracture has healed, and I would certainly expect that he might be able to play hockey by mid April.

Having a 13 yo myself, I understnd how eager he must be to resume play, and I think it's reasonable to have him re-evaluated and re-xrayed to assess whether the fracture may be healed.

Best to you.