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Metacarpal Fractures
From WikiSM
Contents
Other Names
- Metacarpal fracture
- Hand fracture
Background
Oblique fracture of the 5th metacarpal proximal shaft.[1]
- This page refers fracture of one or more Metacarpal Bones
- Boxers Fracture (5th), Rolando Fracture (1st), and Bennett Fracture (1st) are discussed separately
History
Epidemiology
- Represents 5-10% of emergency department visits [2]
- Accounts for 35-40% of all hand fractures (need citation)
Pathophysiology
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
- Muscles insertions to consider
Risk Factors
- Male
- Ages 10-29
Differential Diagnosis
Differential Diagnosis Finger And Hand Pain
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
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).[3]
There are transverse fractures through the shafts of the second to fifth metacarpal bones with no intra-articular extension[4]
Radiographs
- Standard Radiographs Hand
- Brewerton View for metacarpal head fractures
- Roberts View for thumb CMC fracture-dislocation
- Take note of any intra-articular involvement
Ultrasound
- Role of ultrasound remains undefined
- 5% sensitivity and 98.3% specificity[5]
- 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 |
- Immobilization
- Can cast/ splint as appropriate
- Generally consider Short Arm Cast or Sugar Tong Splint
- 1st digit consider Thumb Spica Splint, Thumb Spica Cast
- 2nd or 3rd digit consider Radial Gutter Splint, Radial Gutter Cast
- 4th or 5th digit consider Ulnar Gutter Splint, Ulnar Gutter Cast
- Can consider Club Cast for athletes looking to RTP sooner
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
Prognosis and Complications
Prognosis
Complications
- Tendon Laceration
- Neurovascular Injury
- Acute Compartment Syndrome
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
- https://www.sportsmedreview.com/blog/evidence-behind-the-non-operative-management-of-metacarpal-fractures/
References
- ↑ Case courtesy of Samir Benoudina, Radiopaedia.org, rID: 21779
- ↑ Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23:19.
- ↑ 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.
- ↑ Case courtesy of Amanda Er, Radiopaedia.org, rID: 95801
- ↑ 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.