Non-thumb metacarpal fracture (head)

Background

• Intra-articular fracture

Examination

• Swelling, decreased ROM, and TTP of MCP joint
• Assess for rotational alignment (rotational malalignment is not tolerated)
• Assess for skin integrity (maintain high index of suspicion for Closed fist infection)

Imaging

• AP, lateral, oblique
  • Angulation assessed on lateral view
• Consider "Brewerton view (X-Ray)" if collateral ligament avulsion fracture suspected

Differential Diagnosis

Hand and Finger Fracture Types

• Non-thumb metacarpal fractures
  • Head
  • Neck
  • Shaft
  • Base
  • Boxer's fracture
• Thumb fracture
• Finger (Phalanx) Fracture
  • Proximal
  • Middle
  • Distal

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
• Remove restrictive clothing, jewelry, etc.

Disposition

• Almost always refer b/c are intraarticular and typically comminuted
• Dorsal MCP wounds and lacerations should be treated as open and contaminated
• Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises

See Also

• Hand and finger fractures
• Boxer's fracture
• Closed fist infection

References

• 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.