Journal of Orthopaedic Surgery and Research, Metacarpal Fractures: Treatment and Complications, https://doi.org/10.1007/s11552-013-9562-1. The treatment plan will depend on the severity of the fracture as noted on the x-rays and the patient’s medical condition, activity level, and desires. Although a fracture may not meet operative criteria by radiographic parameters, surgical fixation may offer a more rapid recovery and minimize lost playing time. It will describe some of the possible signs and symptoms and treatment you will be given. Given this, the ring and small finger metacarpals can tolerate more angulation and displacement, whereas the index and long finger tolerate less. This multiaxial condyloid joint provides the fingers significant radioulnar movement when extended and stability when flexed to allow for power pinch and grip. Fractures in this region are often comminuted, causing additional difficulty with their management. An X‐ray (Figure 1) showed an impacted fracture of the head of the metacarpal, and an MRI (Figure 2) confirmed not only the fracture but also a noncomplete oblique fracture. 16. While many metacarpal fractures do well without surgery, there is a paucity of literature and persistent controversy to guide the treating physician on the best treatment algorithm. Fractures of the first metacarpal (ie, thumb metacarpal) comprise a substantial portion of these fractures. All conform to the basic pentadactyl pattern but are modified for different usages. A forearm-based splint is then applied and held in place with a loose compressive wrap. Beasley RW. A true lateral of the thumb is achieved with the hand pronated 30° and the beam angled 15° distally ( Fig. Kathleen M. Kollitz, Warren C. Hammert, Nicholas B. Vedder, and Jerry I. Huang, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way N.E., Box 354740, Seattle, WA 98105, USADuke University School of Medicine, DUMC 2927, Durham, NC 27710, USA, Department of Orthopaedic Surgery, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 4245 Roosevelt Way N.E., Box 354740, Seattle, WA 98105, USA, Duke University School of Medicine, DUMC 2927, Durham, NC 27710, USA. A report on one hundred and thirty-three cases, Common fractures and dislocations of the hand, The management of delayed union and nonunion of the metacarpals and phalanges, Detecting occult fractures of the metacarpal head: the Brewerton view, Step osteotomy: a precise rotation osteotomy to correct scissoring deformities of the fingers, Prospective outcomes of comminuted periarticular metacarpal and phalangeal fractures treated using a titanium plate system, Comparison of intramedullary nailing versus plate-screw fixation of extra-articular metacarpal fractures, Complications and range of motion following plate fixation of metacarpal and phalangeal fractures, Conservative treatment for closed fifth (small finger) metacarpal neck fractures, Osteomyelitis of the tubular bones of the hand, Mechanical comparison of novel bioabsorbable plates with titanium plates and small-series clinical comparisons for metacarpal fractures. In the sporting world, injuries to the hand and wrist account for 2% to 9% of all injuries, with some studies reporting that metacarpal and phalangeal fractures account for 39.2% of all sports-related fractures. Perhaps you have boxer's fracture. Most people have fractures which are well-aligned, and, therefore, do not require surgery. Within the sphere of metacarpal fractures, fractures involving the 5th metacarpal make up … Metacarpal and phalangeal fractures account for 18% and 23%, respectively, of below-elbow fractures in the general population in the United States and are the most common injuries of the upper extremity. INDICATIONS/CONTRAINDICATIONS The majority of isolated metacarpal fractures are effectively managed with closed reduction and splint immobilization. Fractures of the base of the first metacarpal: current treatment options. , , . For more information view the SAGE Journals Article Sharing page. The majority of Boxer’s fractures will not need surgical treatment. predisposing factors in the treatment of metacarpal fractures in newborn calves. Click the button below for the full-text content, 24 hours online access to download content. When the joint is flexed to approximately 90° degrees, the collateral ligaments are taut, firmly stabilizing the joint. , The volar plate is an important soft tissue structure at the MCP joint that prevents joint hyperextension. , . This does not provide rigid fixation, however, and thus requires a period of protected, immobilization, delaying athletes’ return to play. Preoperative procedures Twenty calves of different breeds, ages, and sexes with distal metacarpal fractures admitted to the teaching hospital were included in this study. This results in the collateral ligaments changing length during range of motion. Excercise moderately with using the injured hand. Furthermore, metacarpal shortening leads to altered interosseous muscle anatomy resulting in changed force ratios and, thus, reduced grasp and grip strength. The treatment you receive for your fractured metacarpal injury will depend on the location of your fracture. The initial management of hand and finger injuries may be performed first by an athletic trainer or sideline physician. Philadelphia: WB Saunders, 1981:208-210. He returned to boxing 1 month after the initial visit without symptoms. An important part of a conservative management of patients with metacarpal fractures at the authors’ institution is the immediate start of home therapy. acceptable degrees of apex dorsal angulation (varies by study, see above table) immobilize MCP joints in 70-90 degrees of flexion, leave PIP joints free; cast for 4 weeks; reduce using Jahss technique 2. These lesions are mainly treated conservatively. Members of _ can log in with their society credentials below. Background: Fifth metacarpal neck fractures (commonly named "boxer's fractures") are the most common metacarpal injuries and usually affect young active people. External fixation is rarely employed in the treatment of hand fractures, and few reports describing this technique have been published. A prospective study, Conservative treatment of boxer's fracture: a retrospective analysis, Bioabsorbable miniplating versus metallic fixation for metacarpal fractures, The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal, Surgical treatment of the boxer's fracture: transverse pinning versus intramedullary pinning, Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. By continuing to browse Hand (N Y). However, it is possible that an athlete can be taken to surgery just to have the fracture set and no hardware placed, but that is unlikely. [Subcapital metacarpal fracture. Clinical Outcomes of Limited Open Intramedullary Headless Screw Fixation of Metacarpal Fracture... Pin vs plate fixation for metacarpal fractures: a meta-analysis. Usually these occur with a forward bend to the bone causing a deformity over the back of the hand. These will not cause any functional problems with your hand. 1 The knuckles at the back of the hand are formed by the end of the metacarpal bones, which also assist or support the hand. Clin Orthop 1987;214: 37-52. Metacarpal fractures can be divided into base, shaft, neck, and head. The purpose of this article is to review non-thumb metacarpal anatomy and treatment protocols for nonoperative management of stable fractures, and compare existing literature on surgical techniques for treatment of acute fractures and complications. A unique consideration for operative fixation of metacarpal fractures in athletes is return to play. 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