Non-thumb metacarpal fracture (head): Difference between revisions
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*Intra-articular fracture | *Intra-articular fracture | ||
== | ==Clinical Features== | ||
*Swelling, decreased ROM, and TTP of MCP joint | *Swelling, decreased ROM, and TTP of MCP joint | ||
==Differential Diagnosis== | |||
{{Hand and finger fractures DDX}} | |||
==Evaluation== | |||
===Physical=== | |||
*Assess for rotational alignment (rotational malalignment is not tolerated) | *Assess for rotational alignment (rotational malalignment is not tolerated) | ||
*Assess for skin integrity (maintain high index of suspicion for [[Closed fist infection]])<ref name="Hand and wrist emergencies">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.</ref> | *Assess for skin integrity (maintain high index of suspicion for [[Closed fist infection]])<ref name="Hand and wrist emergencies">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.</ref> | ||
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**Angulation assessed on lateral view | **Angulation assessed on lateral view | ||
*Consider "[[Brewerton view (X-Ray)]]" if collateral ligament avulsion fracture suspected | *Consider "[[Brewerton view (X-Ray)]]" if collateral ligament avulsion fracture suspected | ||
==Management== | ==Management== | ||
Revision as of 12:19, 16 October 2016
Background
- Intra-articular fracture
Clinical Features
- Swelling, decreased ROM, and TTP of MCP joint
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
Physical
- Assess for rotational alignment (rotational malalignment is not tolerated)
- Assess for skin integrity (maintain high index of suspicion for Closed fist infection)[1]
Imaging
- AP, lateral, oblique
- Angulation assessed on lateral view
- Consider "Brewerton view (X-Ray)" if collateral ligament avulsion fracture suspected
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[2]
- Remove restrictive clothing, jewelry, etc.
Disposition
- Almost always refer because are intraarticular and typically comminuted
- Dorsal MCP wounds and lacerations should be treated as open and contaminated[1]
- Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises
See Also
References
- ↑ 1.0 1.1 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.
- ↑ http://dx.doi.org/10.1016/j.jhsa.2008.04.010.