Fractures of the digits and metacarpals: when to splint and when to repair?

Fractures of the digits and the metacarpals are common injuries in athletes. The majority of these can be treated nonoperatively with careful attention to alignment, rotation, and shortening. Those requiring operative fixation are usually amenable to either K-wire, interfragmentary screw, or plate fixation. Whichever treatment pathway is chosen, the goal should be to provide adequate stability for healing while attempting to maintain mobility of the joints and digits. Dedicated rehabilitation is essential to optimizing functional outcomes, patient satisfaction, and return to sport.