Non-thumb metacarpal fracture (shaft): Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "fx " to "fracture ") |
Neil.m.young (talk | contribs) (Text replacement - "* " to "*") |
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==Examination== | ==Examination== | ||
* TTP along affected metacarpal | *TTP along affected metacarpal | ||
* Flexion at MCP is difficult | *Flexion at MCP is difficult | ||
* Assess for extensor dysfunction; patient may exhibit "pseudo-clawing" during attempts at finger extension | *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 | ||
* Assess rotational alignment | *Assess rotational alignment | ||
==Imaging== | ==Imaging== | ||
* Oblique fracture are more prone to shorten and rotate | *Oblique fracture are more prone to shorten and rotate | ||
* Transverse fracture generally stable (particularly isolated 3rd or 4th MC shaft fx) | *Transverse fracture generally stable (particularly isolated 3rd or 4th MC shaft fx) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Treatment== | ==Treatment== | ||
*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]] | *[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]] | ||
* Acute reduction indicated if there is pseudo-clawing or significant angulation | *Acute reduction indicated if there is pseudo-clawing or significant angulation | ||
** Closed reduction generally corrects angulation but typically does not restore length | **Closed reduction generally corrects angulation but typically does not restore length | ||
==Disposition== | ==Disposition== | ||
* Refer: | *Refer: | ||
** Malrotation | **Malrotation | ||
** Comminution | **Comminution | ||
** Shortening > 5mm (refer all shortening if not familiar with fracture management) | **Shortening > 5mm (refer all shortening if not familiar with fracture management) | ||
** 2 or more metacarpal fractures | **2 or more metacarpal fractures | ||
** Unacceptable angulation | **Unacceptable angulation | ||
** Long oblique fractures | **Long oblique fractures | ||
==See Also== | ==See Also== | ||
Revision as of 12:14, 4 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 fracture are more prone to shorten and rotate
- Transverse fracture 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 fracture management)
- 2 or more metacarpal fractures
- Unacceptable angulation
- Long oblique fractures