Non-thumb metacarpal fracture (neck): Difference between revisions
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Revision as of 15:32, 25 June 2016
Examination
- TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture
- Loss of the normal knuckle contour
- Due to dorsal angulation of fracture apex due to pull of the interosseous muscles
- Assess angulation
- Head-to-neck angle of the metacarpals is normally 15 degrees
- Fracture angulation = measured angle minus 15 deg
- Angle toleration (below which there is no adverse functional outcome)
- 2nd MC < 10 deg
- 3rd MC < 20 deg
- 4th MC < 30 deg
- 5th MC < 30-40 deg
- Head-to-neck angle of the metacarpals is normally 15 degrees
- Assess rotational alignment by looking for overlap of the 5th over the 4th digit (scissoring or psuedoscissoring)
- Assess extensor apparatus
- Assess skin integrity
Differential Diagnosis
Hand and Finger Fracture Types
Treatment
- Ulnar Gutter Splint or Radial Gutter Splint]
- MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion[1]
- Acute reduction indicated:
- Pseudoclawing
- Significantly angulated 4th or 5th MC fx
Dispoition
- Refer for:
- Comminution
- Rotational malalignment
See Also
References
- ↑ Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.