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HWN Suggests

Metacarpal Fractures

Why do we care so much about a few small bones in the hand? Because missed injuries can lead to permanent disabilities--we (as well as our patients) need our hands for pretty much everything.

How to assess for these injuries? Do your typical hand exam but pay special attention to: Rotational alignment! Have the patient flex at the MCP and PIP, forming a loose fist with the DIPs extended (as in the figure below, to the left). The axis of each digit should merge near mid wrist. Rotational malalignment will cause deviation of this axis for the injured digit.Rotational malalignment is usually an indication for operative repair, so be sure to check for it.

Don't forget: Any open wound…

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Featured

 How to Handle Metacarpal Fractures

A functional evaluation of the hand is important when assessing metacarpal injuries. Put simply, this is an assessment of how the hand can perform basic functions such as opposition pinch and, most importantly, grip. This provides perhaps the most reliable information regarding what deformity or angulation can or cannot be tolerated.

 PV card: Metacarpal fractures

Patients with rotation deformities of the fingers from a metacarpal fracture should be reduced. All fingers should normally point towards the patient’s scaphoid bone. Metacarpal (MC) fractures are common injuries, which often spark discussions about whether they should be reduced in the ED urgently.

Articles of Interest

Boxer's Break: Metacarpal Fractures

Closed reduction is indicated if there is unacceptable angulation or rotational malalignment. This is because inappropriate recognition of metacarpal fractures with unacceptable angulation or rotational deformities may result in long term weakness in grip strength, or functional deficits related to a “scissoring” effect of a malrotated digit. Unacceptable angulation is defined as >10 ° in the second and third metacarpals, >20 ° in the fourth metacarpal, and >30 ° in the fifth metacarpal.4 The fourth and fifth metacarpals have an excellent capacity for remodeling and can tolerate more deformity because of their increased mobility relative to the second and third metacarpals. Additionally, the intermetacarpal ligaments and surrounding musculature make these fractures inherently more stable and more amenable to conservative treatment.

Boxer’s fracture

Currently there is no consensus on the correct management of boxer’s fracture. Immobilisation, functional treatment/minimal immobilisation can all be used with similar result. Discussion of the case with local hand or orthopaedic surgeon, will develop treatment plan and follow up, and will generally guide further management.

EM@3AM: Metacarpal Base Fractures

Management first metacarpal including gamekeeper's thumb.

Finger Tip Injuries, Jersey Finger, PIP Dislocations, Metacarpal Fractures, Thumb Injuries, Tendon Lacerations

A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Rolando fracture is a three-part or comminuted intra-articular fracture-dislocation of the base of the proximal first metacarpal. It can be thought of as a comminuted Bennet Fracture that splits the bone like an axe splitting wood. Like the Bennet fracture, a Rolando fracture is caused by an axial force applied to the thumb in flexion. Rolando fractures are unstable fractures that require surgical fixation.

Let us take a moment to digest a morsel of metacarpal fractures..

Hands are, obviously, useful. They allow kids (and all of us) to explore, interact, and manipulate the world. This utility, however, often places them in precarious situations and hazardous locations. Hand injuries are commonly encountered in our EDs (ex, Subungal Hematoma, Wrist Fractures) and, since the hand is such an important tool, it deserves specific attention. Let us take a moment to digest a Morsel of Metacarpal Fractures:

Management of Fifth Metacarpal Neck Fracture (Boxer's Fracture): A Literature Review

Conservative management is the preferred option for closed, non-angulated, non-malrotated fractures while open fractures, significant angulation, rotational deformity, and intra-articular extension are recognised indications for surgical intervention.

Metacarpal Fractures

Open fractures and concomitant open tendinous/joint injuries (e.g. fight bite) require immediate orthopedic evaluation for possible operative management. Most fractures are simple and closed and can be managed with gutter splinting and close referral. Pay attention for rotational deformities, associated open injuries, and compartment syndromes.

Resources

Minor Hand Injuries

Mallet finger, Boxer's Fracture and Bennet and Roland fx.

Physiopedia

The splinting of the fracture should be: 20 degrees wrist extension; MCP joint 60-70 degree flexion and IP joint extension.