First Metacarpal Fx (Pedi)

  Initial Treatment
Splint type & position Thumb spica splint
Wrist, 30-degree extension; IP joint, free
Initial follow-up visit 5 to 7 days
Pt instructions Icing and elevation of hand for 24 to 48 hours
  Follow-up Care
Cast or Splint type & position Short-arm thumb spica cast
Wrist, 30-degree extension; IP joint, free
Length of immobilization 4 to 6 weeks
Healing time 6 to 8 weeks
Follow-up visit interval Every 2 weeks
Repeat radiography interval At initial visit to check position; then every 2 to 4 weeks
Pt instruction Maintain IP joint, elbow, and shoulder ROM
Indications for orthopedic consult Irreducible or unstable type II fracture
Type III or IV fracture
Malunion with subluxation of CMC joint


Salter-Harris type II fracture at the base of the thumb metacarpal. The most common pattern is shown here with a “metaphyseal flag” medially (toward ulnar side of the hand) (arrow)