Non-thumb metacarpal fracture (shaft): Difference between revisions
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== | ==Background== | ||
*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> | |||
*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> | |||
==Clinical Features== | |||
*TTP along affected metacarpal | *TTP along affected metacarpal | ||
*Flexion at MCP is difficult | *Flexion at MCP is difficult | ||
==Differential Diagnosis== | |||
{{Hand and finger fractures DDX}} | |||
==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 for extensor dysfunction; patient may exhibit "pseudo-clawing" during attempts at finger extension | ||
*Assess angulation | *Assess angulation | ||
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*Assess rotational alignment | *Assess rotational alignment | ||
== | ==Management== | ||
{{General Fracture Management}} | |||
== | ===Acute Reduction=== | ||
== | |||
*Acute reduction indicated if there is pseudo-clawing or significant angulation | *Acute reduction indicated if there is pseudo-clawing or significant angulation | ||
**Closed reduction generally corrects angulation but typically does not restore length | **Closed reduction generally corrects angulation but typically does not restore length | ||
{{Metacarpal fracture goals}} | |||
===Immobilization=== | |||
*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]] | |||
==Disposition== | ==Disposition== | ||
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 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
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