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| ==Non-Thumb Metacarpal Head Fracture== | | ==Types== |
| *Intra-articular Fx | | *[[Non-thumb metacarpal fracture (head)]] |
| *Examination | | *[[Non-thumb metacarpal fracture (neck)]] |
| **Swelling, decreased ROM, and TTP of MCP joint
| | *[[Non-thumb metacarpal fracture (shaft)]] |
| **Assess for rotational alignment (rotational malalignment is not tolerated)
| | *[[Non-thumb metacarpal fracture (base)]] |
| **Assess for skin integrity (r/o fight bite) | | *[[Boxer's fracture]] |
| *Imaging | |
| **AP, lateral, oblique
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| ***Angulation assessed on lateral view
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| **Consider "Brewerton" view if collateral ligament avulsion fx suspected
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| *Treatment
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| **Ulnar or radial gutter splint
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| ***MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion
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| *Dispo
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| **Almost always refer b/c are intraarticular and typically comminuted
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| **Non-displaced fx can be splinted for 2-3 weeks followed by ROM exercises | |
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| ==Non-Thumb Metacarpal Neck Fracture== | | ==Differential Diagnosis== |
| *Examination
| | {{Hand and finger fractures DDX}} |
| **TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture
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| **Loss of the normal knuckle contour
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| ***Due to dorsal angulation of fracture apex due to pull of the interosseous muscles
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| **Assess angulation
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| ***Head-to-neck angle of the metacarpals is normally 15 degrees
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| ****Fracture angulation = measured angle minus 15 deg
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| ***Angle toleration (below which there is no adverse functional outcome)
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| ****2nd MC < 10 deg
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| ****3rd MC < 20 deg
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| ****4th MC < 30 deg
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| ****5th MC < 30 deg
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| **Assess rotational alignment
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| **Assess extensor apparatus
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| **Assess skin integrity
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| *Treatment
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| **Gutter splint
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| ***MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion
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| **Acute reduction indicated:
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| ***Pseudoclawing
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| ***Significantly angulated 4th or 5th MC fx
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| *Dispo
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| **Refer for:
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| ***Comminution
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| ***Rotational malalignment
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| ==Non-Thumb Metacarpal Shaft Fracture== | | ==Evaluation== |
| * Examination
| | [[File:Neck Fracture of the Fourth Metacarpal Bone.png|thumb|Boxer's Fracture (4th metacarpal)]] |
| ** TTP along affected metacarpal
| | [[File:Fractured5thMetacarpalHead2018.jpg|thumb|Boxer's Fracture (5th metacarpal)]] |
| ** Flexion at MCP is difficult
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| ** Assess for extensor dysfunction; pt may exhibit "pseudo-clawing" during attempts at finger extension
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| ** Assess angulation
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| *** >10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction
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| ** Assess rotational alignment
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| * Imaging
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| ** Oblique fx are more prone to shorten and rotate
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| ** Transverse fx generally stable (particularly isolated 3rd or 4th MC shaft fx)
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| * Treatment
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| ** Gutter splint
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| ** Acute reduction indicated if there is pseudo-clawing or significant angulation
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| *** Closed reduction generally corrects angulation but typically does not restore length
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| * Dispo
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| ** Refer:
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| *** Malrotation
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| *** Comminution
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| *** Shortening > 5mm (refer all shortening if not familiar with fx management)
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| *** 2 or more metacarpal fractures
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| *** Unacceptable angulation
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| *** Long oblique fractres
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| ==Non-Thumb Metacarpal Base Fracture== | | ==Treatment== |
| * Examination
| | {{General Fracture Management}} |
| ** Movement at the wrist elicits pain
| | {{Metacarpal fracture goals}} |
| ** Assess for ulnar deficits (finger abduction/adduction)
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| ** Assess for rotational alignment
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| * Imaging
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| ** AP, lateral, oblique
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| ** 30 deg obliques pronated and supinated if usual films unable to visualize the MC bases
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| ** Consider CT if index of suspicion high for occult fx despite "negative" plain films
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| * Treatment
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| ** Dorsal and volar splints with the wrist in 30 deg of extension and MCP joints free
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| * Dispo
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| ** Refer for:
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| *** Intraarticular fx
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| *** Extraarticular fx with malrotation
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| *** Dislocation of metacarpal base CMC joint;
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| *** Ulnar nerve injury
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| *** 5th metacarpal base fx (typically require sx)
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| ==See Also== | | ==See Also== |
| *[[Hand Fracture]] | | *[[Hand and finger fractures]] |
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| ==Source== | | ==References== |
| UpToDate
| | <references/> |
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| [[Category:Ortho]] | | [[Category:Orthopedics]] |
