Non-thumb metacarpal fracture: Difference between revisions

Latest revision as of 22:23, 22 March 2023

Types

Differential Diagnosis

Hand and Finger Fracture Types

Evaluation

Boxer's Fracture (4th metacarpal)

Boxer's Fracture (5th metacarpal)

Treatment

General Fracture Management

Acute pain management
Open fractures require immediate IV antibiotics and urgent surgical washout
Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
Consider risk for compartment syndrome

Metacarpal Fracture (Post-Reduction) Goals

Finger	Shaft Angulation (degrees)	Shaft Shortening (mm)	Neck Angulation (degrees)	Rotational Deformity
Index & Long Finger	10-20	2-5	10-15	None
Ring Finger	30	2-5	30-40	None
Little Finger	40	2-5	50-60	None

References

Authors:

@@ Line 1: / Line 1: @@
-==[[Non-thumb metacarpal fracture (head)]]==
+==Types==
-==[[Non-thumb metacarpal fracture (neck)]]==
+*[[Non-thumb metacarpal fracture (head)]]
-==[[Non-thumb metacarpal fracture (shaft)]]==
+*[[Non-thumb metacarpal fracture (neck)]]
-===Examination===
+*[[Non-thumb metacarpal fracture (shaft)]]
-* TTP along affected metacarpal
+*[[Non-thumb metacarpal fracture (base)]]
-* Flexion at MCP is difficult
+*[[Boxer's fracture]]
-* Assess for extensor dysfunction; pt may exhibit "pseudo-clawing" during attempts at finger extension
-* Assess angulation
-** >10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction
-* Assess rotational alignment
-===Imaging===
-* Oblique fx are more prone to shorten and rotate
-* Transverse fx generally stable (particularly isolated 3rd or 4th MC shaft fx)
 ==Differential Diagnosis==
 {{Hand and finger fractures DDX}}
-===Treatment===
+==Evaluation==
-*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]]
+[[File:Neck Fracture of the Fourth Metacarpal Bone.png|thumb|Boxer's Fracture (4th metacarpal)]]
-* Acute reduction indicated if there is pseudo-clawing or significant angulation
+[[File:Fractured5thMetacarpalHead2018.jpg|thumb|Boxer's Fracture (5th metacarpal)]]
-** Closed reduction generally corrects angulation but typically does not restore length
-===Dispo===
-* Refer:
-** Malrotation
-** Comminution
-** Shortening > 5mm (refer all shortening if not familiar with fx management)
-** 2 or more metacarpal fractures
-** Unacceptable angulation
-** Long oblique fractures
-==[[Non-thumb metacarpal fracture (base)]]==
-===Examination===
-* Movement at the wrist elicits pain
-* Assess for ulnar deficits (finger abduction/adduction)
-* Assess for rotational alignment
-===Imaging===
-* AP, lateral, oblique
-* 30 deg obliques pronated and supinated if usual films unable to visualize the MC bases
-* Consider CT if index of suspicion high for occult fx despite "negative" plain films
-==Differential Diagnosis==
-{{Hand and finger fractures DDX}}
-===Treatment===
+==Treatment==
-* Dorsal and [[Forearm Volar Splint‎]] with the wrist in 30 deg of extension and MCP joints free
+{{General Fracture Management}}
-===Dispo===
+{{Metacarpal fracture goals}}
-* Refer for:
-** Intraarticular fx
-** Extraarticular fx with malrotation
-** Dislocation of metacarpal base CMC joint;
-** Ulnar nerve injury
-** 5th metacarpal base fx (typically require sx)
 ==See Also==
 *[[Hand and finger fractures]]
-*[[Boxer's fracture]]
-==Source==
+==References==
 <references/>
-[[Category:Ortho]]
+[[Category:Orthopedics]]