This is an educational template, not a substitute for in-person examination. The correct plan depends on which metacarpal is fractured, whether it is the thumb, and whether there is displacement, rotation, joint involvement, an open wound, or neurovascular injury.

1. Paracetamol (acetaminophen) 500 mg tablets
   Take 1-2 tablets orally every 6-8 hours as needed for pain.
   Maximum: 3,000 mg in 24 hours unless a clinician advises otherwise. Avoid or seek advice in significant liver disease or heavy alcohol use.
2. Ibuprofen 400 mg tablets
   Take 1 tablet orally every 8 hours after food as needed for pain for up to 3-5 days.
   Avoid if there is peptic ulcer disease, kidney disease, anticoagulant use, NSAID allergy/asthma sensitivity, uncontrolled hypertension, or pregnancy. Do not combine with other NSAIDs.
3. Immobilization
   • 2nd or 3rd metacarpal: radial-gutter splint.
   • 4th or 5th metacarpal: ulnar-gutter splint.
   • 1st metacarpal/thumb: thumb-spica splint and urgent hand/orthopedic review.
   • Splint in intrinsic-plus position: MCP joints flexed about 70-90°, with IP joints extended.
     Nondisplaced fractures are commonly managed with the relevant gutter splint, with clinical review about every 2 weeks. Pfenninger and Fowler's Procedures for Primary Care, Third Edition, p. 1323.
4. Supportive advice
   • Elevate the hand above heart level for the first 48-72 hours.
   • Apply a wrapped cold pack for 10-15 minutes, 3-4 times/day during the first 48 hours. Do not apply ice directly to skin.
   • Keep the splint clean and dry.
   • Move the shoulder, elbow, and unsplinted fingers as advised to reduce stiffness. Stable injuries may begin gentle hand movement early, while unstable fractures may require 10-14 days of immobilization. NHS hand-fracture guidance
   • No lifting, gripping, punching, contact sports, or manual work with that hand until cleared.
5. Follow-up
   • Hand/orthopedic clinic in 5-7 days for reassessment and repeat imaging if advised.
   • Typical immobilization is around 3-4 weeks for a stable non-thumb metacarpal injury, but this varies by fracture pattern. Healing often takes around 6 weeks, with heavy gripping/contact sport delayed longer. Plymouth NHS advice