Non-thumb metacarpal fracture (base)

Background

  • Reverse Bennett: fracture of fifth metacarpal base, with extensor carpi ulnaris traction on distal metacarpal while proximal fragment still algined with carpals

Clinical Features

  • Movement at the wrist elicits pain
  • Assess for ulnar deficits (finger abduction/adduction)
  • Assess for rotational alignment

Differential Diagnosis

Hand and Finger Fractures

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

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)

See Also

References