Hi michaela
The main take away here is that the fifth metacarpal is most often managed conservatively. Surgical fixation usually occurs with open fractures or crush injuries. All of the other metacarpals have a much lower tolerance to angulation and would most likely require surgery to preserve function. Basically if on the exam there is mention of splinting for the 5th metacarpal after fracture that is usually a good bet. Here is a reference for you van Aaken J, Fusetti C, Luchina S, Brunetti S, Beaulieu JY, Gayet-Ageron A, Hanna K, Shin AY, Hofmeister E. Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial. Arch Orthop Trauma Surg. 2016 Jan;136(1):135-42
Happy studying
Nick