METACARPAL FRACTURES

Question 1

3 factors to consider in management of MC fractures

Answer 1

1. Finger involved
2. Location of fracture = head/ neck/ shaft/ base
3. Displacement = angulation/ shortening/ rotation

Question 2

Most common location for MC fractures

Answer 2

5th MC neck

Question 3

Mechanism of injury for MC fractures

Answer 3

Punch injury/ closed-fist injury against hard surface

Question 4

Mobile vs. non-mobile metacarpals

Answer 4

1st, 4th and 5th MC form mobile borders
2nd and 3rd MC form stiff central pillars
2nd MC is most firmly fixed

Question 5

Clinical assessment of rotational deformity with MC fractures

Answer 5

Look at position of fingernail in partial flexion and full flexion. Compare to other side

Question 6

Special radiographic views for MC fractures

Answer 6

1. Roberts = best for thumb CMC fractures/ dislocations
2. IR oblique = best for 2nd and 3rd CMC fractures/ dislocations
3. ER oblique = best for 4th and 5th CMC fractures/ dislocations
4. Brewerton = best for MC head fractures

Question 7

Indications for nonoperative management of MC fractures

Answer 7

1. Nondisplaced intra-articular fractures
2. Fractures with acceptable angulation and shortening
   Acceptable angulation by finger:
   - IF and MF 10-20deg
   - RF 30deg
   - LF 40deg
   Acceptable shortening < 5mm
3. No rotational deformity
   Immobilise in position of safety (70-90deg flexion) for 4 wks

Question 8

Indications for surgical management of MC fractures

Answer 8

1. Open fractures
2. Displaced intra-articular fractures = most MC head #
3. Multiple MC shaft fractures = loss of inherent stability from border digits
4. Significant angulation or shortening
5. Any rotational malalignment

Question 9

Jahss technique for MC neck fractures

Answer 9

CR technique
MCPJ flexion to 90deg
Dorsally directed pressure through proximal phalanx while stabilising MC shaft