Non-thumb metacarpal fracture (shaft): Difference between revisions
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* TTP along affected metacarpal | * TTP along affected metacarpal | ||
* Flexion at MCP is difficult | * Flexion at MCP is difficult | ||
* Assess for extensor dysfunction; | * Assess for extensor dysfunction; patient may exhibit "pseudo-clawing" during attempts at finger extension | ||
* Assess angulation | * Assess angulation | ||
** >10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction | ** >10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction | ||
Revision as of 20:20, 1 July 2016
Examination
- TTP along affected metacarpal
- Flexion at MCP is difficult
- Assess for extensor dysfunction; patient 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 Fracture Types
Treatment
- Ulnar Gutter Splint or Radial Gutter Splint]
- Acute reduction indicated if there is pseudo-clawing or significant angulation
- Closed reduction generally corrects angulation but typically does not restore length
Disposition
- Refer:
- Malrotation
- Comminution
- Shortening > 5mm (refer all shortening if not familiar with fx management)
- 2 or more metacarpal fractures
- Unacceptable angulation
- Long oblique fractures