On-line CEUs

TIP OF THE MONTH: November/December 2006
The Berkhalter Immobilization for Metacarpal Fractures
Cynthia Henderson, OTC, CO and Melissa Patterson, OTC

Metacarpal fractures have always been a challenge to immobilize. The Berkhalter Method allows for early flexion in both the involved fingers and the associated fingers that have to be immobilized to control the fracture site.

Case Study

The patient is a 23 year-old female who sustained a Right 4th Metacarpal oblique fracture. The fracture site was first immobilized using the long familiar ulnar gutter splint. At 7 days post injury out of splint x-rays taken and patient placed in a Berkhalter Cast.

Materials Necessary:

2 - 2” or 3” rolls of Synthetic Casting Tape
1 - 2” roll of Synthetic Cast Padding
1 - 4” Strip of adhesive felt (optional)
1 - 8-10 “ 2” or 3” Stockinet

Position patient’s hand in the intrinsic plus position (Fig 1).



Apply the stockinet with cut out for the thumb and allowing stockinet to extend a few inches past the distal end of the patient’s fingers. Once stockinet is applied, then apply cast padding with limiting amount under the fingers but applying extra layers on the dorsal aspect to the hand and fingers.

Begin to roll the Synthetic Cast Tape. You should have a good buttress of casting material over the dorsal aspect of the fingers to prevent extension. You may achieve the extra material by fan splinting over the top of the hand. You will want to limit the amount of tape on the volar aspect since the area between the tips of the fingers to the palmar crease will be removed to allow for full flexion of the fingers (Fig 2).



Cut away the casting tape and padding on the volar area to the palmar crease. Then use the adhesive felt to tack down the stockinet. Use the final roll of 2”

Patient should have full flexion of PIP, MIP and MCP joints while maintaining the fracture site. With flexion motion during fracture healing, the patient should return to full range of motion sooner than if immobilized for the full treatment in a ulnar gutter splint or cast.


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