Non-thumb metacarpal fracture (head): Difference between revisions
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*Swelling, decreased ROM, and TTP of MCP joint | *Swelling, decreased ROM, and TTP of MCP joint | ||
*Assess for rotational alignment (rotational malalignment is not tolerated) | *Assess for rotational alignment (rotational malalignment is not tolerated) | ||
*Assess for skin integrity ( | *Assess for skin integrity (maintain high index of suspicion for [[Closed fist infection]]) | ||
==Imaging== | ==Imaging== | ||
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*[[Ulnar Gutter Splint]] or Short arm cast that extends to the PIP joint | *[[Ulnar Gutter Splint]] or Short arm cast that extends to the PIP joint | ||
**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref> | **In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref> | ||
*Remove restrictive clothing, jewelry, etc. | |||
==Disposition== | ==Disposition== | ||
*Almost always refer b/c are intraarticular and typically comminuted | *Almost always refer b/c are intraarticular and typically comminuted | ||
*Dorsal MCP wounds and lacerations should be treated as open and contaminated | |||
*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises | *Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises | ||
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*[[Hand and finger fractures]] | *[[Hand and finger fractures]] | ||
*[[Boxer's fracture]] | *[[Boxer's fracture]] | ||
*[[Closed fist infection]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
*German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013. | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 01:17, 11 October 2016
Background
- Intra-articular fracture
Examination
- Swelling, decreased ROM, and TTP of MCP joint
- Assess for rotational alignment (rotational malalignment is not tolerated)
- Assess for skin integrity (maintain high index of suspicion for Closed fist infection)
Imaging
- AP, lateral, oblique
- Angulation assessed on lateral view
- Consider "Brewerton view (X-Ray)" if collateral ligament avulsion fracture suspected
Differential Diagnosis
Hand and Finger Fracture Types
Management
- Ulnar Gutter Splint or Short arm cast that extends to the PIP joint
- In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers[1]
- Remove restrictive clothing, jewelry, etc.
Disposition
- Almost always refer b/c are intraarticular and typically comminuted
- Dorsal MCP wounds and lacerations should be treated as open and contaminated
- Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises
See Also
References
- German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.