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| ==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===
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| *AP, lateral, oblique
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| **Angulation assessed on lateral view
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| *Consider "Brewerton" view if collateral ligament avulsion fx suspected
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| ===Treatment===
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| *[[Ulnar Gutter Splint]] or Short arm cast that extends to the PIP joint | |
| **In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>
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| ===Dispo===
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| *Almost always refer b/c are intraarticular and typically comminuted
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| *Non-displaced fx can be splinted for 2-3 weeks followed by ROM exercises
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| ==Neck==
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| ===Examination===
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| *TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture
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| *Loss of the normal knuckle contour
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| **Due to dorsal angulation of fracture apex due to pull of the interosseous muscles
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| *Assess angulation
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| **Head-to-neck angle of the metacarpals is normally 15 degrees
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| ***Fracture angulation = measured angle minus 15 deg
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| **Angle toleration (below which there is no adverse functional outcome)
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| ***2nd MC < 10 deg | |
| ***3rd MC < 20 deg
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| ***4th MC < 30 deg
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| ***5th MC < 30-40 deg
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| *Assess rotational alignment by looking for overlap of the 5th over the 4th digit (scissoring or psuedoscissoring)
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| *Assess extensor apparatus
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| *Assess skin integrity
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| ===Treatment===
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| *[[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>
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| *Acute reduction indicated:
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| **Pseudoclawing
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| **Significantly angulated 4th or 5th MC fx
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| ===Dispo===
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| *Refer for:
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| **Comminution
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| **Rotational malalignment
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| ==Shaft== | | ==Differential Diagnosis== |
| ===Examination===
| | {{Hand and finger fractures DDX}} |
| * TTP along affected metacarpal
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| * Flexion at MCP is difficult
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| * Assess for extensor dysfunction; pt may exhibit "pseudo-clawing" during attempts at finger extension
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| * Assess angulation
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| ** >10 deg in 2nd and 3rd and >20 deg in 4th and 5th metacarpal shaft fractures requires reduction
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| * Assess rotational alignment
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| ===Imaging===
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| * Oblique fx are more prone to shorten and rotate
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| * Transverse fx generally stable (particularly isolated 3rd or 4th MC shaft fx)
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| ===Treatment===
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| *[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]]
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| * Acute reduction indicated if there is pseudo-clawing or significant angulation
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| ** Closed reduction generally corrects angulation but typically does not restore length
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| ===Dispo===
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| * Refer:
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| ** Malrotation
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| ** Comminution
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| ** Shortening > 5mm (refer all shortening if not familiar with fx management)
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| ** 2 or more metacarpal fractures
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| ** Unacceptable angulation
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| ** Long oblique fractures
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| ==Base==
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| ===Examination===
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| * Movement at the wrist elicits pain
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| * Assess for ulnar deficits (finger abduction/adduction)
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| * Assess for rotational alignment
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| ===Imaging===
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| * AP, lateral, oblique
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| * 30 deg obliques pronated and supinated if usual films unable to visualize the MC bases
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| * Consider CT if index of suspicion high for occult fx despite "negative" plain films
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| ===Treatment===
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| * Dorsal and [[Forearm Volar Splint]] with the wrist in 30 deg of extension and MCP joints free
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| ===Dispo===
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| * Refer for:
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| ** Intraarticular fx
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| ** Extraarticular fx with malrotation
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| ** Dislocation of metacarpal base CMC joint;
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| ** Ulnar nerve injury
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| ** 5th metacarpal base fx (typically require sx)
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| ==See Also== | | ==See Also== |
| *[[Hand and finger fractures]] | | *[[Hand and finger fractures]] |
| *[[Boxer's fracture]]
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| ==Source== | | ==References== |
| <references/> | | <references/> |
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| [[Category:Ortho]] | | [[Category:Orthopedics]] |