Non-thumb metacarpal fracture (shaft)


  • 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

Hand and Finger Fracture Types



  • Hand x-rays
    • Oblique fracture are more prone to shorten and rotate
    • Transverse fracture generally stable (particularly isolated 3rd or 4th MC shaft fracture)


  • 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


General Fracture 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



  • 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


  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.