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Background
- Extensor tendons and the FDS attach to the middle phalanx[1]
- Commonly will have volar angulation due to interosseous muscles and extensor tendon attachments[1]
Clinical Features
- TTP along affected metacarpal
- Flexion at MCP is difficult
Differential Diagnosis
Evaluation
Imaging
- Hand x-rays
- Oblique fracture are more prone to shorten and rotate
- Transverse fracture generally stable (particularly isolated 3rd or 4th MC shaft fracture)
Physical
- Assess for extensor dysfunction; patient may exhibit "pseudo-clawing" during attempts at finger extension
- Assess angulation
- >10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction
- Assess rotational alignment
Management
Acute Reduction
- Acute reduction indicated if there is pseudo-clawing or significant angulation
- Closed reduction generally corrects angulation but typically does not restore length
Metacarpal Fracture (Post-Reduction) Goals
| Finger
|
Shaft Angulation (degrees)
|
Shaft Shortening (mm)
|
Neck Angulation (degrees)
|
Rotational Deformity
|
| Index & Long Finger |
10-20 |
2-5 |
10-15 |
None
|
| Ring Finger |
30 |
2-5 |
30-40 |
None
|
| Little Finger |
40 |
2-5 |
50-60 |
None
|
Immobilization
Disposition
- Refer:
- Malrotation
- Comminution
- Shortening > 5mm (refer all shortening if not familiar with fracture management)
- 2 or more metacarpal fractures
- Unacceptable angulation
- Long oblique fractures
See Also
References
- ↑ 1.0 1.1 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.
