HERSHEY, PA. — Short-term, nonsurgical management of hand fractures gets competitive athletes back in the game, Dr. Michael R. Redler said at the annual meeting of the American Orthopaedic Society for Sports Medicine.
But it is essential to remind the athlete of all possible outcomes, including the increased risk for additional injury if he or she returns to play too soon after a fracture.
Study results have shown that hand injuries account for 3%–25% of all athletic injuries, said Dr. Redler, a founding partner of the Orthopaedic and Sports Medicine Center in Trumbull, Conn.
The timing and feasibility of an injured athlete's return to play differ for each sport and each individual. Factors to consider include the patient's age and competitive level, the type of injury sustained, whether the athlete can perform the manual skill necessary for the sport, and whether the injury can be protected from further trauma.
Athletes who require explicit use of the wrist or fingers may not be able to participate in their sport during the stages of healing. Phalangeal fractures can usually be managed with external plastic or aluminum splints, and surgery is rarely needed. But metacarpal fractures are more complicated. Most phalangeal fractures are caused by trauma from crushing, bending, or twisting, whereas metacarpal fractures are usually the result of a direct impact from a ball, the ground, or another player.
Most sports-related metacarpal fractures can be treated with closed reduction and casting, and the periosteal sleeve and ligamentous attachments will allow for stable reduction.
But the take-home message is that athletes who resume competition after casting and immobilization require close and frequent radiographic follow-up to make sure there is no displacement of the fracture on a week-to-week basis, Dr. Redler said. Returning the athlete to play is a balancing act. Protection of the fracture must be a priority, but athletes who are returning to play need enough mobility to perform the necessary skills on the field or court.
To that end, thumb metacarpal fractures can be immobilized in a functional position.
Dr. Redler said that he and his colleagues have advised athletes in sports such as lacrosse or hockey to bring their sticks to the casting clinic or hand therapist to make certain that the cast is molded to match how they hold the sticks.
Fiberglass casts are permitted in many sports if they have enough external padding to protect the other athletes on the field.
If fiberglass is prohibited, thermoplastic splints can be used, but they may be too flexible and may require reinforcement in some cases.