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Metacarpal Fractures

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Other Names

  • Metacarpal fracture
  • Hand fracture

Background

History

Epidemiology

  • Represents 5-10% of emergency department visits [1]
  • Accounts for 35-40% of all hand fractures (need citation)

Pathophysiology

Fracture of 3rd Metacarpal
  • General
    • Involves fracture of one or more Metacarpal Bones
    • Can be divided into base, head, neck and shaft fractures; neck is most common

Etiology

  • Common mechanisms:
    • Motor vehicle accidents
    • Bicycle accidents
    • Blunt trauma
    • Assault
    • Typically occur due a direct blow
    • Fist fight

Pathoanatomy


Risk Factors

  • Male
  • Ages 10-29

Differential Diagnosis


Clinical Features

  • History
    • Important to characterize mechanism
    • Patients report pain, swelling, trouble closing hand
  • Physical: Physical Examination Hand
    • Inspection may reveal ecchymosis, swelling, deformity
    • Important to exclude rotational deformity, open wounds
    • Palpation reveals focal tenderness of the affected bone(s)
    • Range of motion is often reduced
    • Assess for "scissoring" of digits which suggests rotational component
    • Radial and ulnar pulse most often normal, check 2-point discrimination

Evaluation

Images of fracture of the fifth metacarpal. Radiographic image (left) shows an impacted fracture (arrow). In the same patient, the longitudinal ultrasonography scan (right) shows interruption of the bone cortex (white arrow).[2]

Radiographs

Ultrasound

  • Role of ultrasound remains undefined
    • 5% sensitivity and 98.3% specificity[3]
    • Water bath technique can help

CT scan

    • Indication
    • Diagnosis is uncertain
    • multiple dislocations or complex fractures

MRI

  • Indication
    • If the diagnosis is uncertain or if soft tissue injuries are suspected

Classification

  • N/A

Management

Nonoperative

  • Indications
    • Stable, extra-articular
    • No rotational deformity
    • See table for acceptable parameters
Metacarpal Shaft Angulation Shaft Shortening Neck Angulation
2nd, 3rd 10-20 2-5 10-15
4th 30 2-5 30-40
5th 40 2-5 50-60

Operative

  • Indications
    • Open
    • Intra-articular
    • Rotational deformity
    • Significant displacement
    • Multiple fractures
    • Instability
  • Technique
    • ORIF

Rehab and Return to Play

Rehabilitation

  • Post operative care at discretion of surgeon

Return to Play/ Work

  • Typically after 6-8 weeks of healing whether managed operatively or non-operatively
  • May consider protective casting in some cases (i.e. football lineman) and allow RTP sooner

Complications and Prognosis

Prognosis

Complications


See Also


References


  1. Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23:19.
  2. Neri, Elena, et al. "Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients." Archives of disease in childhood 99.12 (2014): 1087-1090.
  3. Blaivas, Michael, et al. “Water bath evaluation technique for emergency ultrasound of painful superficial structures.” The American journal of emergency medicine 22.7 (2004): 589-593.
Created by:
John Kiel on 26 June 2019 22:45:37
Authors:
Last edited:
15 May 2022 00:07:17
Categories:
Trauma | Osteology | Hand | Fractures | Acute