Non-thumb metacarpal fracture: Difference between revisions

(Text replacement - "==Source== <references/>" to "==References== <references/>")
(15 intermediate revisions by 3 users not shown)
Line 1: Line 1:
==Head==
==Types==
===Background===
*[[Non-thumb metacarpal fracture (head)]]
*Intra-articular Fx
*[[Non-thumb metacarpal fracture (neck)]]
===Examination===
*[[Non-thumb metacarpal fracture (shaft)]]
*Swelling, decreased ROM, and TTP of MCP joint
*[[Non-thumb metacarpal fracture (base)]]
*Assess for rotational alignment (rotational malalignment is not tolerated)
*[[Boxer's fracture]]
*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 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
===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


==Neck==
==Differential Diagnosis==
===Examination===
{{Hand and finger fractures DDX}}
*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 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 deg
*Assess rotational alignment
*Assess extensor apparatus
*Assess skin integrity
===Treatment===
*[[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
*Acute reduction indicated:
**Pseudoclawing
**Significantly angulated 4th or 5th MC fx
===Dispo===
*Refer for:
**Comminution
**Rotational malalignment
 
==Shaft==
===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
** >10 deg in 2nd and 3rd and >20 deg 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===
*[[Ulnar Gutter Splint]] or [[Radial 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 fractures
 
==Base==
===Examination===
* Movement at the wrist elicits pain
* Assess for ulnar deficits (finger abduction/adduction)
* Assess for rotational alignment
===Imaging===
* 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 fx despite "negative" plain films
===Treatment===
* Dorsal and [[Forearm Volar Splint‎]] with the wrist in 30 deg of extension and MCP joints free
===Dispo===
* Refer for:
** Intraarticular fx
** Extraarticular fx with malrotation
** Dislocation of metacarpal base CMC joint;
** Ulnar nerve injury
** 5th metacarpal base fx (typically require sx)


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


==Source==
==References==
UpToDate
<references/>


[[Category:Ortho]]
[[Category:Orthopedics]]

Revision as of 15:52, 25 June 2016