lystn

Podcast Video

Show Notes

Background:

• 40% of all hand fractures
• A metacarpal fracture can occur at any point along the bone (head, neck, shaft, or base)
• “Boxer’s” fractures classically at neck
• Most common mechanism: direct axial load with a clenched fist
• Most common metacarpal injured is the 5^th
• A majority of these injuries are isolated injuries, closed and stable

Examination:

• Ensure that this is an isolated injury
• May note a loss of knuckle contour or shortening
• A thorough evaluation of the skin is important
  • Patients may also have fight bites and require irrigation and antibiotics
• Tender along the dorsum of the affected metacarpal
• Evaluate the range of motion as the commonly seen shortening results in extension lag
  • For every 2 mm of shortening there is going to be a 7 degree decrease in ability to extend the joint
• Check rotational alignment of digits with the MCP and PIP at 50% flexion.
  • Partially clench their fist and ensure that the axis of each digit converges near the scaphoid pole / mid wrist

• Deformity is often seen due to the imbalance of volar and dorsal forces
  • Dorsal angulation
• AP, lateral and oblique views should be obtained on XR
• The degree of angulation is estimated with the lateral v...