Metacarpal Fractures

HPI: Patient punched a wall

Physical exam: Right hand with significant soft tissue swelling dorsally and TTP over third metacarpal.

Metacarpal Fractures:
            General Principles

• Divided into fractures of metacarpal head, neck, and shaft
  
• Treatment is based on which metacarpal is involved and location of fx
  
• Acceptable angulation varies by location (See chart below)
  
• No degree of malrotation is acceptable

Acceptable Angulation

Treatment:
            Immobilization: Indications for non-operative immobilization are
1.)    Stable fracture pattern
2.)    Acceptable angulation
3.)    no rotational deformity
4.)    Shortening of less than 5mm

Splinting:
•       Fracture splints should be forearm-based and should allow for motion of the interphalangeal (IP) joints.
•       Splints should extend over the dorsal and palmar aspect of the entire metacarpal being treated.
•       Generally, the wrist should be placed in 20-30° of extension; the metacarpophalangeal (MCP) joints should be immobilized in 70-90° of flexion, with the dorsal aspect of the splint extending to the IP joints; and the volar aspect should end at the distal palmar crease.
•       Buddy taping the fingers of the involved metacarpal can aid in maintaining rotational control.