Non-thumb metacarpal fracture: Difference between revisions

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==[[Non-thumb metacarpal fracture (head)]]==
==[[Non-thumb metacarpal fracture (head)]]==
==[[Non-thumb metacarpal fracture (neck)]]==
==[[Non-thumb metacarpal fracture (neck)]]==
===Examination===
*TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture
*Loss of the normal knuckle contour
**Due to dorsal angulation of fracture apex due to pull of the interosseous muscles
*Assess angulation
**Head-to-neck angle of the metacarpals is normally 15 degrees
***Fracture angulation = measured angle minus 15 deg
**Angle toleration (below which there is no adverse functional outcome)
***2nd MC < 10 deg
***3rd MC < 20 deg
***4th MC < 30 deg
***5th MC < 30-40 deg
*Assess rotational alignment by looking for overlap of the 5th over the 4th digit (scissoring or psuedoscissoring)
*Assess extensor apparatus
*Assess skin integrity
==Differential Diagnosis==
{{Hand and finger fractures DDX}}
===Treatment===
*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]]
**MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.</ref>
*Acute reduction indicated:
**Pseudoclawing
**Significantly angulated 4th or 5th MC fx
===Dispo===
*Refer for:
**Comminution
**Rotational malalignment
==[[Non-thumb metacarpal fracture (shaft)]]==
==[[Non-thumb metacarpal fracture (shaft)]]==
===Examination===
===Examination===

Revision as of 08:11, 10 January 2015

Non-thumb metacarpal fracture (head)

Non-thumb metacarpal fracture (neck)

Non-thumb metacarpal fracture (shaft)

Examination

  • TTP along affected metacarpal
  • Flexion at MCP is difficult
  • 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 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

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 Fracture Types

Treatment

Dispo

  • 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

Source

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