Non-thumb metacarpal fracture (head)

Background

  • Intra-articular fracture

Clinical Features

  • Swelling, decreased ROM, and TTP of MCP joint

Differential Diagnosis

Hand and Finger Fractures

Evaluation

Physical

  • Assess for rotational alignment (rotational malalignment is not tolerated)
  • Assess for skin integrity (maintain high index of suspicion for Closed fist infection)[1]

Imaging

  • AP, lateral, oblique
    • Angulation assessed on lateral view
  • Consider "Brewerton view (X-Ray)" if collateral ligament avulsion fracture suspected

Management

  • 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[2]
  • Remove restrictive clothing, jewelry, etc.

Disposition

  • Almost always refer because are intraarticular and typically comminuted
  • Dorsal MCP wounds and lacerations should be treated as open and contaminated[1]
  • Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises

See Also

References

  1. 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.
  2. http://dx.doi.org/10.1016/j.jhsa.2008.04.010.