Splints and immobilisation approaches used for second to fifth metacarpal fractures: a systematic review

BACKGROUND: The second to fifth metacarpal fractures are immobilised with splints, plaster of Paris (POP) or buddy strapping for a period of time. However, no recent evidence-based splinting and immobilisation programme exists for the management thereof, leaving a gap in the literature to inform clinical practice. This review aimed to review, appraise and collate the literature on splints and immobilisation approaches used for second to fifth metacarpal fractures after surgical and conservative management in adults aged 20 to 59 years. METHODS: The review included experimental study designs, quasi-experimental studies, cohort studies and case-control studies from January 2008 to September 2018. Two reviewers independently screened, selected, appraised and extracted data from the included studies. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guided the reporting. Joanna Briggs Institute (jBl) critical appraisal tools were used to assess the risk of bias for each included study. RESULTS: Database searches generated 1 005 articles with ten additional articles found on Google Scholar. Ten articles were included: two randomised controlled trials (RCTs), one quasi-RCT, four prospective studies, one retrospective record review, one retrospective study and one comparative study with descriptive reporting of the results. CONCLUSION: High level 1b evidence suggests that no reduction, a soft wrap and buddy strapping for three weeks with early active finger and wrist mobilisation are effective for individuals who sustained boxer's fractures with < 70° angulation. To guide clinical practice, high-level research is needed to determine the immobilisation of second to fifth metacarpal fracture types. Level of evidence: Level 2