Hand Case 9 ED Management
Reduction is indicated in the ED if the alignment of the thumb is grossly abnormal, such as >40 degrees angulation or malrotation.
Immobilization requires a thumb spica splint made of 3 inch plaster from just distal to 1st IP joint to mid-forearm with 25 degrees extension at the CMC joint and 0 degrees at the MCP and IP joints.
Hand surgery should be consulted emergently if this is an open fracture. Early referral to a hand surgeon for definitive management is recommended in all closed fractures. Surgery is indicated in the presence of large volar or dorsal fragments amenable to fixation. Highly comminuted fractures may be managed non-operatively or with external fixation and percutaneous pinning.