Metacarpal Fractures

Fractures

 

1.  Neck of 5th Metacarpal

2.  Metacarpal Shaft

3.  Metacarpal Head

4.  Base of Metacarpal Fracture Dislocations

5.  Base of Thumb Fractures / Bennett's / Rolanda

 

1.  Neck of 5th Metacarpal Fracture

 

Non operative Management

 

Accept 45o angulation

- will have finger extensor lag, but will recover

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

 

Neck of Fifth Metacarpal Fracture

 

Operative Treatment

 

Rare

- K wire across MC head into 4th MC

 

2.  Metacarpal Shaft Fracture

 

Acceptable Deformity

 

Rotation < 5o

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

< 5 mm shortening

 

Metacarpal Fracture Minimally Displaced

 

Operative Management

 

Options

- plate

- lag screws (if spiral fracture)

- intramedullary wires

 

Metacarpal 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

 

Metacarpal Base Fracture Dislocation APMetacarpal Base Fracture Dislocation LateralBase of Metacarpal Dislocation CT

 

5.  Base of Thumb Metacarpal

 

Types

A.  Bennett's

B.  Rolando

- Y shaped intra-articular

 

A.  Bennett's Fracture

 

Bennetts Fracture APBennetts Fracture LateralBennetts CT

 

Fracture

- oblique intra-articular fracture

- small volar fragment remains in situ as attached to beak ligament

- metacarpal displaces proximally and dorsally due to APL

- inherently unstable

 

Management

- closed reduction

- longitudinal traction on metacarpal

- use thumb to reduce metacarpal shaft

- use 2 x K wires to pin metacarpal to trapezium / trapezoid

- 6 weeks in thumb spica cast

 

Bennetts FractureBennetts K wireBennetts ORIF

 

Bennett K wires

 

B.  Rolando Fracture

 

Fracture

- 2 small intra-articular fragments

- poor prognosis

 

Operative management

- for significant displacement

- dorsal approach

- protect superficial radial nerves

- between APL / EPB and EPL

- attempt to anatomically reduce and fix with plate