Non-thumb metacarpal fracture (shaft)

Background

• Extensor tendons and the FDS attach to the middle phalanx
• Commonly will have volar angulation due to interosseous muscles and extensor tendon attachments

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 fracture)

Differential Diagnosis

Hand and Finger Fracture Types

• Non-thumb metacarpal fractures
  • Head
  • Neck
  • Shaft
  • Base
  • Boxer's fracture
• Thumb fracture
• Finger (Phalanx) Fracture
  • Proximal
  • Middle
  • Distal

Management

• 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

See Also

• Hand and finger fractures

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.