Non-thumb metacarpal fracture (shaft): Difference between revisions
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==Background== | ==Background== | ||
*Extensor tendons and the FDS attach to the middle phalanx | *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 | *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 | ||
**>10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction | **>10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction | ||
*Assess rotational alignment | *Assess rotational alignment | ||
==Management== | ==Management== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
Revision as of 11:10, 16 October 2016
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
- Ulnar Gutter Splint or Radial Gutter Splint]
- Acute reduction indicated if there is pseudo-clawing or significant angulation
- Closed reduction generally corrects angulation but typically does not restore length
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