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 (rule out fight bite)

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

Disposition

• Almost always refer b/c are intraarticular and typically comminuted
• Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises

See Also

• Hand and finger fractures
• Boxer's fracture