View source for Non-thumb metacarpal fracture (neck)

==Background==

==Clinical Features==
*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

==Differential Diagnosis==
{{Hand and finger fractures DDX}}

==Examination==
*Hand xrays

===Hand Examination===
*Assess angulation<ref name="Hand and wrist emergencies">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.</ref>
**Head-to-neck angle of the metacarpals is normally 15 degrees
***Fracture angulation = measured angle minus 15 deg
**Angle toleration (below which there is no adverse functional outcome)
***2nd MC < 10 deg
***3rd MC < 20 deg
***4th MC < 30 deg
***5th MC < 30-40 deg
*Assess rotational alignment by looking for overlap of the 5th over the 4th digit (scissoring or psuedoscissoring)
*Assess extensor apparatus
*Assess skin integrity

==Management==
{{General Fracture Management}}

===Acute Reduction===
*Acute reduction indicated:
**Pseudo-clawing
**Significant angulation (>10-15 degrees of the 2nd through 4th fingers, 20-30 degrees of the 5th) <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
**Any rotational misalignment
*Reduction technique:
**Pain control and/or [[Hematoma block]]
**Flex MCP joint to 90 degrees then apply axial traction while placing pressure over metacarpal shaft
**[[Radial gutter splint]] if 2nd/3rd MCP fractures, [[Ulnar gutter splint]] if 4th/5th. Immobilize with wrist extended 20-30 degrees and MCP flexed 90 degrees
**Can be difficult to reduce or maintain reduction. Early hand referral if not successful

{{Metacarpal fracture goals}}

===Immobilization===
*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]
**MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.</ref>

==Disposition==
*Outpatient

===Refer for===
*Comminution
*Rotational malalignment
*Unsuccessful reduction if required<ref name="Hand and wrist emergencies">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.</ref>

==See Also==
*[[Hand and finger fractures]]

==References==
<references/>

[[Category:Orthopedics]]