Non-thumb metacarpal fracture (neck): Difference between revisions
(Text replacement - "fx" to "fracture") |
(added reduction technique, other detail) |
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**Pseudoclawing | **Pseudoclawing | ||
**Significantly angulated 4th or 5th MC fracture | **Significantly angulated 4th or 5th MC fracture | ||
**Rotational malalignment | |||
*Reduction technique: | |||
**Pain control and/or hematoma block | |||
**Flex MCP joint then apply axial traction while placing pressure over metacarpal shaft | |||
**Can be difficult to reduce or maintain reduction. Early hand referral if not successful | |||
===Dispoition=== | ===Dispoition=== | ||
| Line 29: | Line 34: | ||
**Comminution | **Comminution | ||
**Rotational malalignment | **Rotational malalignment | ||
**Unsuccessful reduction if required | |||
==See Also== | ==See Also== | ||
Revision as of 13:30, 11 October 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
Management
- 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 fracture
- Rotational malalignment
- Reduction technique:
- Pain control and/or hematoma block
- Flex MCP joint then apply axial traction while placing pressure over metacarpal shaft
- Can be difficult to reduce or maintain reduction. Early hand referral if not successful
Dispoition
- Refer for:
- Comminution
- Rotational malalignment
- Unsuccessful reduction if required
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.