Non-thumb metacarpal fracture (base): Difference between revisions
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== | ==Background== | ||
*Reverse Bennett: fracture of fifth metacarpal base, with extensor carpi ulnaris traction on distal metacarpal while proximal fragment still algined with carpals | |||
**See [[Thumb fracture]] for Bennett fracture | |||
==Clinical Features== | |||
*Movement at the wrist elicits pain | *Movement at the wrist elicits pain | ||
*Assess for ulnar deficits (finger abduction/adduction) | *Assess for ulnar deficits (finger abduction/adduction) | ||
*Assess for rotational alignment | *Assess for rotational alignment | ||
== | ==Differential Diagnosis== | ||
*AP, lateral, oblique | {{Hand and finger fractures DDX}} | ||
==Evaluation== | |||
*Xray hand: AP, lateral, oblique | |||
*30 deg obliques pronated and supinated if usual films unable to visualize the MC bases | *30 deg obliques pronated and supinated if usual films unable to visualize the MC bases | ||
*Consider CT if index of suspicion high for occult fracture despite "negative" plain films | *Consider CT if index of suspicion high for occult fracture despite "negative" plain films | ||
==Management== | ==Management== | ||
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==Disposition== | ==Disposition== | ||
*Refer for: | *Refer for: | ||
**Intraarticular | **Intraarticular fracture | ||
**Extraarticular fracture with malrotation | **Extraarticular fracture with malrotation | ||
**Dislocation of metacarpal base CMC joint; | **Dislocation of metacarpal base CMC joint; | ||
**Ulnar nerve injury | **Ulnar nerve injury | ||
**5th metacarpal base fracture (typically require | **5th metacarpal base fracture (typically require surgery) | ||
==See Also== | ==See Also== | ||
Latest revision as of 16:17, 27 October 2016
Background
- Reverse Bennett: fracture of fifth metacarpal base, with extensor carpi ulnaris traction on distal metacarpal while proximal fragment still algined with carpals
- See Thumb fracture for Bennett fracture
Clinical Features
- Movement at the wrist elicits pain
- Assess for ulnar deficits (finger abduction/adduction)
- Assess for rotational alignment
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
- Xray hand: AP, lateral, oblique
- 30 deg obliques pronated and supinated if usual films unable to visualize the MC bases
- Consider CT if index of suspicion high for occult fracture despite "negative" plain films
Management
- Dorsal and Forearm Volar Splint with the wrist in 30 deg of extension and MCP joints free
Disposition
- Refer for:
- Intraarticular fracture
- Extraarticular fracture with malrotation
- Dislocation of metacarpal base CMC joint;
- Ulnar nerve injury
- 5th metacarpal base fracture (typically require surgery)