Non-thumb metacarpal fracture (shaft): Difference between revisions

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==Examination==
==Background==
* TTP along affected metacarpal
*Extensor tendons and the FDS attach to the middle phalanx<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>
* Flexion at MCP is difficult
*Commonly will have volar angulation due to interosseous muscles and extensor tendon attachments<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 extensor dysfunction; pt 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==
==Clinical Features==
* Oblique fx are more prone to shorten and rotate
*TTP along affected metacarpal
* Transverse fx generally stable (particularly isolated 3rd or 4th MC shaft fx)
*Flexion at MCP is difficult


==Differential Diagnosis==
==Differential Diagnosis==
{{Hand and finger fractures DDX}}
{{Hand and finger fractures DDX}}


==Treatment==
==Evaluation==
*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]]
===Imaging===
* Acute reduction indicated if there is pseudo-clawing or significant angulation
*Hand x-rays
** Closed reduction generally corrects angulation but typically does not restore length
**Oblique fracture are more prone to shorten and rotate
**Transverse fracture generally stable (particularly isolated 3rd or 4th MC shaft fracture)
 
===Physical===
*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
 
==Management==
{{General Fracture Management}}
 
===Acute Reduction===
*Acute reduction indicated if there is pseudo-clawing or significant angulation
**Closed reduction generally corrects angulation but typically does not restore length
 
{{Metacarpal fracture goals}}
 
===Immobilization===
*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]


==Disposition==
==Disposition==
* Refer:
*Refer:
** Malrotation
**Malrotation
** Comminution
**Comminution
** Shortening > 5mm (refer all shortening if not familiar with fx 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==

Latest revision as of 02:53, 18 September 2019

Background

  • Extensor tendons and the FDS attach to the middle phalanx[1]
  • Commonly will have volar angulation due to interosseous muscles and extensor tendon attachments[1]

Clinical Features

  • TTP along affected metacarpal
  • Flexion at MCP is difficult

Differential Diagnosis

Hand and Finger Fracture Types

Evaluation

Imaging

  • Hand x-rays
    • Oblique fracture are more prone to shorten and rotate
    • Transverse fracture generally stable (particularly isolated 3rd or 4th MC shaft fracture)

Physical

  • 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

Management

General Fracture Management

Acute Reduction

  • Acute reduction indicated if there is pseudo-clawing or significant angulation
    • Closed reduction generally corrects angulation but typically does not restore length

Metacarpal Fracture (Post-Reduction) Goals

Finger Shaft Angulation (degrees) Shaft Shortening (mm) Neck Angulation (degrees) Rotational Deformity
Index & Long Finger 10-20 2-5 10-15 None
Ring Finger 30 2-5 30-40 None
Little Finger 40 2-5 50-60 None

Immobilization

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

References

  1. ↑ 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.
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