|
|
| (29 intermediate revisions by 3 users not shown) |
| Line 1: |
Line 1: |
| ===Background===
| | [[File:Hand bones.svg|thumb|Hand bones]] |
|
| |
|
| | ==Types== |
| | {{Hand and finger fractures DDX}} |
|
| |
|
| * Splinting is used in the initial immobilization of, and often is the definitive treatment for, metacarpal fractures
| | ==Differential Diagnosis== |
| * Maintenance of the MCP joint in flexion is important to avoid immobility contractures of the collateral ligaments
| | {{Hand and finger injury DDX}} |
| === ===
| |
|
| |
|
| | ==See Also== |
| | *[[Fractures (Main)]] |
| | *[[Hand Diagnoses (Main)]] |
|
| |
|
| ===Thumb metacarpal Fx=== | | ==References== |
| | | <references/> |
| | | [[Category:Orthopedics]] |
| * Classification
| |
| * Type I (Bennett's Fx)
| |
| * Fx-dislocation of the base of the metacarpal (intraarticular)
| |
| * Type II (Rolando's Fx)
| |
| * Comminuted version of a Bennett's fracture (intraarticular)
| |
| * Type III
| |
| * Extraarticular (transverse or oblique)
| |
| * Type IV
| |
| * Extraarticular pediatric fx involving the proximal physis
| |
| * Examination
| |
| * Important to distinguish tenderness at base of 1st MC from injury to scaphoid, trapezium, or distal radius
| |
| * If pain or ecchymosis occurs more distally at the MCP (particularly on the ulnar side) consider ulnar collateral ligament injury (Game Keeper's Thumb)
| |
| * Imaging
| |
| * AP, lateral, oblique
| |
| * Treatment
| |
| * Splinting
| |
| * Type I, II - Thumb-spica with the IP joint free and wrist in 30º of extension
| |
| * Type III - Short arm thumb-spica extening to the IP joint and wrist in 30º of extension
| |
| * RICE
| |
| * Significant swelling or overly aggressive icing to radial side of thumb may result in temporary palsy to the superficial radial nerve (numbness over the dorsum of the thumb)
| |
| * Reduction
| |
| * Indicated for:
| |
| * Angulated extraarticular fx if clinician is comfortable with the procedure
| |
| * Dispo
| |
| * Refer within 3-5 days:
| |
| * All intraarticular fractures warrant referral (most require sx)
| |
| * Extraarticular fractures that cannot be adequately reduced
| |
| === ===
| |
| | |
| | |
| ===Non-Thumb Metacarpal Head Fx===
| |
| | |
| | |
| * Intra-articular Fx
| |
| * Examination
| |
| * Swelling, decreased ROM, and TTP of MCP joint
| |
| * Assess for rotational alignment (rotational malalignment is not tolerated)
| |
| * Assess for skin integrity (r/o fight bite)
| |
| * Imaging
| |
| * AP, lateral, oblique
| |
| * Angulation assessed on lateral view
| |
| * Consider "Brewerton" view if collateral ligament avulsion fx suspected
| |
| * Treatment
| |
| * Ulnar or radial gutter splint
| |
| * MCP joints in 70-90º flexion, wrist in 20-30º extension, PIP and DIP joints in 5-10º of flexion
| |
| * Dispo
| |
| * Almost always refer b/c are intraarticular and typically comminuted
| |
| * Non-displaced fx can be splinted for 2-3 weeks followed by ROM exercises
| |
|
| |
| | |
| ===Non-Thumb Metacarpal Neck Fx===
| |
| | |
| | |
| * Examination
| |
| * 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
| |
| * Assess angulation
| |
| * Head-to-neck angle of the metacarpals is normally 15 degrees
| |
| * Fracture angulation = measured angle minus 15º
| |
| * Angle toleration (below which there is no adverse functional outcome)
| |
| * 2nd MC < 10º
| |
| * 3rd MC < 20º
| |
| * 4th MC < 30º
| |
| * 5th MC < 30º
| |
| * Assess rotational alignment
| |
| * Assess extensor apparatus
| |
| * Assess skin integrity
| |
| * Treatment
| |
| * Gutter splint
| |
| * MCP joints in 70-90º flexion, wrist in 20-30º extension, PIP and DIP joints in 5-10º of flexion
| |
| * Acute reduction indicated:
| |
| * Pseudoclawing
| |
| * Significantly angulated 4th or 5th MC fx
| |
| * Dispo
| |
| * Refer for:
| |
| * Comminution
| |
| * Rotational malalignment
| |
|
| |
| | |
| ===Non-Thumb Metacarpal Shaft Fx===
| |
| | |
| | |
| * Examination
| |
| * TTP along affected metacarpal
| |
| * Flexion at MCP is difficult
| |
| * Assess for extensor dysfunction; pt may exhibit "pseudo-clawing" during attempts at finger extension
| |
| * Assess angulation
| |
| * >10º in 2nd and 3rd and >20º in 4th and 5th metacarpal shaft fractures requires reduction
| |
| * Assess rotational alignment
| |
| * Imaging
| |
| * Oblique fx are more prone to shorten and rotate
| |
| * Transverse fx generally stable (particularly isolated 3rd or 4th MC shaft fx)
| |
| * Treatment
| |
| * Gutter splint
| |
| * Acute reduction indicated if there is pseudo-clawing or significant angulation
| |
| * Closed reduction generally corrects angulation but typically does not restore length
| |
| * Dispo
| |
| * Refer:
| |
| * Malrotation
| |
| * Comminution
| |
| * Shortening > 5mm (refer all shortening if not familiar with fx management)
| |
| * 2 or more metacarpal fractures
| |
| * Unacceptable angulation
| |
| * Long oblique fractres
| |
|
| |
| | |
| ===Non-Thumb Metacarpal Base Fx===
| |
| | |
| | |
| * Examination
| |
| * Movement at the wrist elicits pain
| |
| * Assess for ulnar deficits (finger abduction/adduction)
| |
| * Assess for rotational alignment
| |
| * Imaging
| |
| * AP, lateral, oblique
| |
| * 30º obliques pronated and supinated if usual films unable to visualize the MC bases
| |
| * Consider CT if index of suspicion high for occult fx despite "negative" plain films
| |
| * Treatment
| |
| * Dorsal and volar splints with the wrist in 30º of extension and MCP joints free
| |
| * Dispo
| |
| * Refer for:
| |
| * Intraarticular fx
| |
| * Etraarticular fx with malrotation
| |
| * Dislocation of metacarpal base CMC joint;
| |
| * Ulnar nerve injury
| |
| * 5th metacarpal base fx (typically require sx)
| |
| ==Source==
| |
| | |
| | |
| UpToDate
| |
| | |
| | |
| | |
| | |
| [[Category:Ortho]] | |
