Metacarpal Fractures

Fractures

 

1.  Neck of 5th Metacarpal

2.  Metacarpal Shaft

3.  Metacarpal Head

4.  Base of Metacarpal Fracture Dislocations

5.  MCPJ dislocations

 

1.  Neck of 5th Metacarpal Fracture

 

Non operative Management

 

Accept 45^o angulation

- will have finger extensor lag, but will recover

- can ring block and manipulate in POSI cast to improve position

 

 

Operative Treatment

 

Rare

- K wire across MC head into 4th MC

 

2.  Metacarpal Shaft Fracture

 

Acceptable Deformity

 

Rotation < 5^o

10^o / 20^o / 30^o / 40^o in IF / MF / RF / LF

< 5 mm shortening

 

 

Operative Management

 

Options

- plate

- lag screws (if spiral fracture)

- intramedullary wires

 

 

3.  Metacarpal Head Fracture

 

Epidemiology

- uncommon

- usually in index finger

 

Indication for surgery

- > 2mm angulation

 

Options

- T plate

- headless compression screws / intra-articular

 

4.  Base of Metacarpal Fracture Dislocations

 

 

Can be missed

- may need CT to diagnose

 

Management

- reduce joint closed +/- open 

- dorsal approach

- K wire

 

5. MCPJ Dislocation

 

 

 

Simple

 

- volar plate not interposed

 

- MCPJ 90^o hyper-extended

 

- reduce via wrist flexion and volar translation of PP

 

- avoid hyperextension and axial distraction which may convert this injury to a complex dislocation

 

- extension blocking splint 3-4 weeks

 

 

 

Complex

 

- volar plate / lumbrical tendon / flexor tendons interposed

 

- joint space widened

 

- requires open reduction, dorsal or volar

 

- volar more direct but risk NV bundles

 

- protected motion post operatively