METACARPAL FRACTURES

Question 1

MANAGEMENT & DOCUMENTATION: BOXER’S

Answer 1

MECHANISM
Punch
->Laxity of 4th & 5th intercarpal ligaments
-> # of metacarpal neck

PHYSICAL EXAM
Point tenderness of the metacarpal neck
Ensure no open fracture
CHECK FOR ROTATION

XRAY
PA
Oblique:
Best view for Thumb
Lateral:
Best View for Dorsal / Volar displacement
1. Outline cortex on every phalangy and metacarpal
2. Metacarpal Neck: Check Palmar Angulation

ACCEPTABLE PALMAR ANGULATION
40 in the 5th
30 in the 4th
20 in the 3rd
10 in the 2nd

REDUCTION

Ulnar Nerve Block
Hematoma Block: 3-5 ml 1-2% Xylocaine
Traction with chinese finger trap
OR
90:90 boxer’s fracture reduction

POST REDUCTION
Assess post reduction rotation
Ulnar Gutter
Follow up with hand in 1 week

NO REDUCTION
Ulner Gutter
Follow up with hand

LONG TERM MANAGEMENT
Umber gutter cast for 3 weeks
Removable liner gutter splint 3 weeks (reading, writing, arithmetic)
Light strengthening / protected activity for 6 weeks
NO SPORTS / HEAVY LIFTING FOR 3 months total

Question 2

MANAGEMENT & DOCUMENTATION: BENNETT’S (BASE OF 1ST MC INTRA-ARTICULAR FRACTURE DISLOCATION)

Answer 2

MECHANISM
Impaction form striking a fixed object:

Intraarticular fracture dislocation base of 1st metacarpal
-> large / radial fragment dislocates
-> smaller / ulnar fragment remains anatomic

XRAY
PA
Oblique:
Best view for Thumb
Lateral:
Best View for Dorsal / Volar displacement
1. Outline cortex on every phalangy and metacarpal
2. Metacarpal Neck: Check Palmar Angulation

MANAGEMENT
Thumb spica
Requires Internal Fixation

Question 3

MANAGEMENT & DOCUMENTATION: ROLONDO (BASE OF 1ST MC INTRA-ARTICULAR COMMINUTED FRACTURE)

Answer 3

MECHANISM
Impaction form striking a fixed object:

Comminuted fracture base of 1st metacarpal

XRAY
PA
Oblique:
Best view for Thumb
Lateral:
Best View for Dorsal / Volar displacement
1. Outline cortex on every phalangy and metacarpal
2. Metacarpal Neck: Check Palmar Angulation

MANAGEMENT
Reduction
Thumb spica
Requires Internal Fixation