Non-thumb metacarpal fracture (base): Difference between revisions
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== | ==Background== | ||
* | *Reverse Bennett: fracture of fifth metacarpal base, with extensor carpi ulnaris traction on distal metacarpal while proximal fragment still algined with carpals | ||
* | **See [[Thumb fracture]] for Bennett fracture | ||
* | |||
== | ==Clinical Features== | ||
* | *Movement at the wrist elicits pain | ||
* | *Assess for ulnar deficits (finger abduction/adduction) | ||
* | *Assess for rotational alignment | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hand and finger fractures DDX}} | {{Hand and finger fractures DDX}} | ||
== | ==Evaluation== | ||
* Dorsal and [[Forearm Volar Splint]] with the wrist in 30 deg of extension and MCP joints free | *Xray hand: AP, lateral, oblique | ||
*30 deg obliques pronated and supinated if usual films unable to visualize the MC bases | |||
*Consider CT if index of suspicion high for occult fracture despite "negative" plain films | |||
==Management== | |||
*Dorsal and [[Forearm Volar Splint]] with the wrist in 30 deg of extension and MCP joints free | |||
==Disposition== | ==Disposition== | ||
* Refer for: | *Refer for: | ||
** Intraarticular | **Intraarticular fracture | ||
** Extraarticular | **Extraarticular fracture with malrotation | ||
** Dislocation of metacarpal base CMC joint; | **Dislocation of metacarpal base CMC joint; | ||
** Ulnar nerve injury | **Ulnar nerve injury | ||
** 5th metacarpal base | **5th metacarpal base fracture (typically require surgery) | ||
==See Also== | ==See Also== | ||
Latest revision as of 16:17, 27 October 2016
Background
- Reverse Bennett: fracture of fifth metacarpal base, with extensor carpi ulnaris traction on distal metacarpal while proximal fragment still algined with carpals
- See Thumb fracture for Bennett fracture
Clinical Features
- Movement at the wrist elicits pain
- Assess for ulnar deficits (finger abduction/adduction)
- Assess for rotational alignment
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
- Xray hand: AP, lateral, oblique
- 30 deg obliques pronated and supinated if usual films unable to visualize the MC bases
- Consider CT if index of suspicion high for occult fracture despite "negative" plain films
Management
- Dorsal and Forearm Volar Splint with the wrist in 30 deg of extension and MCP joints free
Disposition
- Refer for:
- Intraarticular fracture
- Extraarticular fracture with malrotation
- Dislocation of metacarpal base CMC joint;
- Ulnar nerve injury
- 5th metacarpal base fracture (typically require surgery)