• Reference Number: HEY-1371-2023
• Departments: Paediatrics, Physiotherapy, Therapies
• Last Updated: 1 August 2023

Introduction

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a Patient-Initiated Follow-Up (PIFU) pathway?

A patient-initiated follow-up (PIFU) means that we will not routinely book you an appointment, instead we are putting you in control of making your own appointments at a time when you need them most, within a given timeframe.

How does PIFU work?

You will have been given this leaflet because your healthcare professional is happy that you do not need to see them again unless you have a problem. If you do have any problems, you can contact the Paediatric Therapy department on the given telephone number and they will arrange an appointment, either by telephone or face-to-face if it is needed.    You will be told how long after your injury that you can contact the Paediatric Therapy department, on the PIFU pathway if you need to be seen.

When should I call for a PIFU?

You can call to make an appointment if you

• are not improving to a level that was expected
• have worsening symptoms relating to your injury/condition
• have a “flare-up”

Please note, you can only initiate a PIFU appointment for the specific injury/condition you were originally referred to the Paediatric Therapy service for.

When should I not use PIFU?

• If your concern is related to different injury/condition
• If the specified time period has lapsed, please contact your GP.
• If you need urgent medical advice you should contact your GP or NHS111.

What if I don’t need a PIFU follow-up appointment?

You do not have to arrange an appointment if you feel it is not required.  If you don’t contact us to book an appointment within the specified timeframe, the PIFU will expire and you will be discharged back to the care of your GP.  We will not contact you to book a PIFU appointment – it must be initiated by you.

What is a metacarpal bone fracture?

As shown in the diagram the metacarpals are the long, thin bones between the wrist bones and finger bones. There are 5 metacarpals, one for the thumb which is known as the 1^st metacarpal and one for each of the fingers.

A fracture is a break to the bone. Your fracture can be described as simple, stable or un-displaced, which means there is a clean break, but the pieces of bone are in the correct place and are unlikely to move out of place.

How should it be treated?

This injury can be treated with neighbour or buddy strapping for 3 weeks, the strapping will provide the bone the stability it needs to heal and will help reduce any pain you may experience. You may also have been given a wrist splint or placed in a cast, this can be used for the same length of time and can be removed at home.

To manage your pain, we advise that you regularly take simple pain relief, which can be bought over the counter at a chemist or supermarket. If you have allergies or conditions, which prevent the use of pain-relieving or anti-inflammatory medication, please seek advice from your GP practice or a pharmacist.

Extra strapping can be purchased from your local chemist and should be replaced when it becomes wet or worn. To prevent stiffness please ensure it is applied above and below the finger joints. This will allow the joint to still move within the strapping

What should I do in the first few days?

Complete rest is not advisable. Whilst in the strapping, it is important that you try to use your wrist and hand normally when doing everyday tasks like washing, dressing and eating.

Exercising the hand early is very important to prevent stiffness at the finger and thumb joints. The following exercises should each be repeated 10 times and completed every 2-3 hours. Support your elbow on the table with your wrist straight.

Swelling and pain

Swelling and pain is a normal reaction following any fracture and may persist for 4-6 weeks or on occasions longer.

The following will help with this:

• Elevating the hand, especially at night on pillows.
• Ice – massage with an ice cube. Remembering to keep it moving.
• Massage along the hand towards the wrist.
• Exercises
• Over the counter pain relief as described earlier.

You may notice a visible lump at the fracture site and this is normal. This lump represents the bone healing process and tends to reduce over several months.

What about play and school?

You can use your hand for light daily activities such as eating, dressing and light school activities as soon as you feel comfortable. Carrying heavy bags or attending PE at school is best avoided until 6 weeks after your injury.

Full contact sport should also be avoided for at least 6 weeks and until you have full range of movement and strength. You should start by practicing sports specific activities; like throwing or catching. Build up these activities gradually from around 6 weeks in order to regain strength and flexibility before returning to full training sessions and competition.

When should I call for a Patient initiated Follow Up (PIFU) appointment?

The fracture usually heals well with a gradual return to normal movement and grip strength.

You should call for a PIFU appointment if:

• You are struggling to make a full fist or reach the base of your little finger with your thumb tip at 3 weeks following your injury.
• You notice the position of a finger or the thumb appears to have changed, such as being at an angle or rotated, especially during movement.
• You feel your movement or function is worsening.
• You feel your pain or swelling worsens.
• You are struggling to return to your daily activities or hobbies after 6 weeks.

If we do not hear from you 3 months following your injury date we will assume that you no longer require any further intervention and will be discharged from the PIFU pathway. If you have further problems with your hand after this date please contact your GP practice.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Paediatric Therapy Department on telephone: 01482 674539.

This leaflet was produced by the Paediatric Therapy Team, Hull University Teaching Hospitals NHS Trust and will be reviewed in August 2026.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.