Non-thumb metacarpal fracture (head)
Background
- Intra-articular fracture
Clinical Features
- Swelling, decreased ROM, and TTP of MCP joint
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
Physical
- Assess for rotational alignment (rotational malalignment is not tolerated)
- Assess for skin integrity (maintain high index of suspicion for Closed fist infection)[1]
Imaging
- AP, lateral, oblique
- Angulation assessed on lateral view
- Consider "Brewerton view (X-Ray)" if collateral ligament avulsion fracture suspected
Management
- Ulnar Gutter Splint or Short arm cast that extends to the PIP joint
- In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers[2]
- Remove restrictive clothing, jewelry, etc.
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 |
Disposition
- Almost always refer because are intraarticular and typically comminuted
- Dorsal MCP wounds and lacerations should be treated as open and contaminated[1]
- Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises
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.
- ↑ http://dx.doi.org/10.1016/j.jhsa.2008.04.010.