Common Hand Fractures

Question 1

List the common hand fractures

Answer 1

• 5th metacarpal neck fracture (Boxer’s fracture)
• 1st metacarpal base fracture (Bennett’s fracture)
• Scaphoid fracture

Question 2

What is the typical mechanism of 5th metacarpal neck fracture? What are the complications?

Answer 2

• Fighting/boxing/punching

- “Fight-bite” - punching a mouth with a clenched fist - risk of infection

Question 3

How are 5th metacarpal neck fractures managed?

Answer 3

• Most can be treated non-operatively in splint/strapping for 2-3 as per local protocol (as most undisplaced or mildly displaced)
• NOTE: metacarpal shaft fractures require cast immobilisation for 3-5 weeks, due to risk of non-unio

Question 4

Describe a 1st metacarpal base fracture?

Answer 4

• INTRA-ARTICULAR

- Requires perfect reduction as intra-articular

Question 5

How are 1st metacarpal base fractures managed?

Answer 5

• Undisplaced: 3 weeks in moulded Bennett’s cast if suitable for non-operative treatment
• Displaced: MUS closed reduction maintained with cast

MUA closed reduction maintained with percutaneous K-wires

GA ORIF (uncommon)

Question 6

What is the typical mechanism of scaphoid fractures?

Answer 6

• FOOSH

- Wrist hyperextension (e.g. goal-keeping)

Question 7

What are important considerations when examining a suspected scaphoid fracture?

Answer 7

• Tenderness at anatomical snuffbox or scaphoid tubercle
• N/V: (e.g. median nerve)
• Open/closed (rarley open), Other sites of injury (e.gother carpal /wrist fractures)

Question 8

What is the appropriate imaging for a scaphoid fracture? What are important considerations?

Answer 8

BEWARE SCAPHOID INJURIES AS X-RAYS ARE DECEIVING & MISSED FRACTURES CAUSE LONGTERM SYMPTOMS

• X-RAYS : SCAPHOID VIEWS OUT OF CAST (most important to remember)
• IF NO VISIBLE FRACTURE BUT TENDER TO SUGGEST FRACTURE, PROVIDE SPLINT/CAST (AS PER LOCAL PROTOCOL) & REPEAT XRAYS & ASSESSMENT AT 7-10 DAYS.
• +/- OTHER SCANS: MRI MORE SENSITIVE THAN CT & MORE SPECIFIC THAN ISOTOPE BONE SCAN)
• IF CLINICAL SUSPICION OF FRACTURE WITHOUT FRACTURE ON X-RAY , IMMOBILISE IN CAST.
• BEWARE SCAPHOLUNATE LIGAMENT INJURIES IF STILL PAIN BUT NO FRACTURE

Question 9

What may increase the risk of AVN of scaphoid/non-union of scaphoid?

Answer 9

• Poor blood supply to scaphoid (espically proximal pole) therefore high risk of non-union or avascular necrosis, especially if
– Inadequate spintage
– Delayed presentation
– Smoking
– NSAID use

Question 10

What may non-union of scaphoid cause?

Answer 10

Widespread wrist arthritis (may need CT to confirm union)

Question 11

How are scaphoid fractures managed?

Answer 11

• Undisplaced: short arm cast
• Displaced: GA closed reduction maintained with percutaneous screw fixation

GA ORIF