HPI: Patient punched a wall
Physical exam: Right hand with significant soft tissue swelling dorsally and TTP over third metacarpal.
Immobilization: Indications for non-operative immobilization are
1.) Stable fracture pattern
2.) Acceptable angulation
3.) no rotational deformity
4.) Shortening of less than 5mm
• 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.
CMC ER Residents
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