METACARPAL FRACTURES - OVERVIEW

Overview

  • Very common fractures, typically from direct trauma
    • Can be spiral, oblique, transverse or comminuted
    • Closed treatment can be successful when length, rotation and length maintained

Evaluation

  • Examine skin for any wounds
  • Determine if any angular or rotational deformity
    • Shortening > 3 mm alters length-tension of intrinsics
    • Malrotation causes scissoring
      • 10 degrees is equal to 1.5 cm of digital overlap in clenched fist

Surgical Indications

  • Unacceptable angulation (depends which metacarpal is fractured):
    • Index: 10 degrees 
    • Middle: 20 degerees
    • Ring: 30 degrees
    • Small: 40 degrees
  • Any malrotation
  • Open fractures
  • Multiple fractures
  • Shortening greater than 3 mm
    • Shortening is limited, especially in central digits, by the deep transverse metacarpal ligament

Nonsurgical Treatment

  • Nondisplaced and stable fractures are treated in a splint or cast in the safe position
  • Unacceptably aligned fractures are treated with closed reduction and casting if stable
    • Dorsal mold over the apex of the fracture to reduce the angulation

Fixation Options

  • Percutaneous pins (longitudinal crossed or transverse)
  • IM pins or screws
  • Lag screws/Plates – require more extensive dissection but rigid fixation allows for earlier motion
  • External fixation– reserved for segmental bone loss or for soft tissue management with open wounds

Complications

  • Stiffness – minimized by early ROM and immobilization in safe position
  • Infection
  • Malunion/Nonunion

References

Baltera RM, Hastings H II, Calfee R, Bozentka D, and Boyer M. “Fractures and Dislocations: Hand.”  ASSH Manual of Hand Surgery. Ed. Hammert WC. Philadelphia: Lippincott Williams & Wilkins. 2010. 93-110. Print. 

Weinstein, Loryn P et al. “Metacarpal fractures.” Journal of the American Society of Surgery of the Hand”, Volume 2 , Issue 4 , 168 - 180

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