$metacarpal fracture$

$metacarpal fracture$

Urgent exploration and washout is required) Open fractures (including fight bites as illustrated above - any laceration over the metacarpal heads should be treated as highly suspicious for these injuries.įractures at the head or base of the metacarpal should not be manipulated in the ED.Ĩ. the 5th metacarpal neck “Boxer’s Fracture”), greater degrees of apex-dorsal angulation may be accepted, so long as the clinical examination doesn’t reveal findings of malrotation, extensor lag (‘pseudoclawing’), or ‘MC head in the palm’ (palpable MC head because of angulation, felt palmarly). For Little Metacarpal: >20 degrees of angulation, or any significant rotational deformityįor metacarpal neck fractures (i.e.For Ring metacarpal: >15 degrees of angulation, or any rotational deformity.For Index and Middle metacarpals: >10 degrees of angulation, or any rotational deformity.When is reduction (non-operative and operative) required?Īs a loose guide for shaft fractures (there are many other factors at play here):

$metacarpal fracture$

To better appreciate any dorsal subluxation in these injuries, a lateral or oblique view should be examinedįor Fractures of the Thumb metacarpal see thumb fracture CPG 7. Left: neck fracture little finger metacarpal (sometimes labelled a “Boxer’s Fracture” when found in little finger metacarpal) What radiological investigations should be ordered?ĪP, lateral and oblique films of the hand This occurs when a tooth penetrates the MCP joint Risk of deep infection here is very high, regardless of whether abnormality is present on the xray: surgical admission for exploration and washout is indicated.ĥ. This is demonstrated in the image below., with the normal exam at left, and rotational deformity of the ring finger shown at right.Īn open wound over the dorsal aspect of the metacarpal head may suggest a “fight bite”. Looking for ‘scissoring’ or overlap of the fingertips. There may be rotational deformity, which is best identified by having the patient flex her fingers into a loose grip. There is usually significant bruising and tenderness in the part of the hand corresponding to the fracture site. They usually occur due to a blunt force applied to a clenched fist such as punching a fixed object or from falling onto a closed fist. Metacarpal fractures are a common injury in older children and adolescents, particularly the little and ring fingers. How common are they and how do they occur? These are classified as closed or open, by which digit is injured, by anatomical site of fracture (base, shaft or neck), and by displacement/angulationģ. Note that fractures of the thumb metacarpal require special consideration: see thumb fracture guideline 2.

$metacarpal fracture$