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 ( | *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> | ||
==Imaging== | ==Imaging== | ||
*AP, lateral, oblique | *AP, lateral, oblique | ||
**Angulation assessed on lateral view | **Angulation assessed on lateral view | ||
*Consider "[[Brewerton view (X-Ray)]]" if collateral ligament avulsion | *Consider "[[Brewerton view (X-Ray)]]" if collateral ligament avulsion fracture suspected | ||
== | ==Management== | ||
{{ | {{General Fracture Management}} | ||
== | ===Specific Management=== | ||
*[[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 | *Almost always refer because are intraarticular and typically comminuted | ||
*Non-displaced | *Dorsal MCP wounds and lacerations should be treated as open and contaminated<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> | ||
*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises | |||
===Indications for Subsequent Out-Patient Orthopedic Surgery=== | |||
*Majority are operative, as no degree of articular displacement is acceptable | |||
==See Also== | ==See Also== | ||
*[[Hand and finger fractures]] | *[[Hand and finger fractures]] | ||
*[[Boxer's fracture]] | *[[Boxer's fracture]] | ||
*[[Closed fist infection]] | |||
==References== | ==References== | ||
Latest revision as of 02:51, 18 September 2019
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
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Specific 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
Indications for Subsequent Out-Patient Orthopedic Surgery
- Majority are operative, as no degree of articular displacement is acceptable
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.