Non-thumb metacarpal fracture (neck): Difference between revisions
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== | ==Background== | ||
==Clinical Features== | |||
*TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture | *TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture | ||
*Loss of the normal knuckle contour | *Loss of the normal knuckle contour | ||
**Due to dorsal angulation of fracture apex due to pull of the interosseous muscles | **Due to dorsal angulation of fracture apex due to pull of the interosseous muscles | ||
==Differential Diagnosis== | |||
{{Hand and finger fractures DDX}} | |||
==Examination== | |||
*Hand xrays | |||
===Hand Examination=== | |||
*Assess angulation<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 angulation<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> | ||
**Head-to-neck angle of the metacarpals is normally 15 degrees | **Head-to-neck angle of the metacarpals is normally 15 degrees | ||
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*Assess extensor apparatus | *Assess extensor apparatus | ||
*Assess skin integrity | *Assess skin integrity | ||
==Management== | ==Management== | ||
*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint | *[[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<ref>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.</ref> | **MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>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.</ref> | ||
===Acute Reduction=== | |||
*Acute reduction indicated: | *Acute reduction indicated: | ||
**Pseudoclawing | **Pseudoclawing | ||
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**Can be difficult to reduce or maintain reduction. Early hand referral if not successful | **Can be difficult to reduce or maintain reduction. Early hand referral if not successful | ||
=== | ===Disposition=== | ||
*Refer for | *Outpatient | ||
===Refer for=== | |||
*Comminution | |||
*Rotational malalignment | |||
*Unsuccessful reduction if required<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> | |||
==See Also== | ==See Also== | ||
Revision as of 11:05, 16 October 2016
Background
Clinical Features
- 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
Differential Diagnosis
Hand and Finger Fracture Types
Examination
- Hand xrays
Hand Examination
- Assess angulation[1]
- 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
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[2]
Acute Reduction
- 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
Disposition
- Outpatient
Refer for
- Comminution
- Rotational malalignment
- Unsuccessful reduction if required[1]
See Also
References
- ↑ 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.
- ↑ 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.