There is a risk of pin tract infection from the exposed pins; however, this can be prevented by burying the pins under the skin whenever possible. Dr. Ebraheim’s educational animated video describes fractures of the metacarpals of the hands. A unique consideration for operative fixation of metacarpal fractures in athletes is return to play. Neumeister MW, Webb K, McKenna K. Non-surgical management of metacarpal fractures. They are treated with immobilization in a plaster cast or splint for a period of 2-6 weeks. Lean Library can solve it. Overview. Metacarpal fractures: treatment and complications. Fracture. Metacarpal neck fractures rarely require surgery. As the bone heals a lump may form over the fracture site. These will not cause any functional problems with your hand. Non-Surgical. INDICATIONS/CONTRAINDICATIONS The majority of isolated metacarpal fractures are effectively managed with closed reduction and splint immobilization. tures of the third, or fourth, metacarpal. Of course … Following review and discussion with a hand surgeon, a metacarpal thermoplastic splint was given to the athlete (including the wrist and the distal interphalangeal joint). A night splint can be given to protect the fracture and decrease pain at nighttime, but during the day, the patient maintains his or her full active range of motion with flexion and extension exercises. 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. The purpose of this prospective, randomized, multicenter trial was to determine if the outcomes of soft wrap and buddy taping (SW) was noninferior to reduction and cast (RC) in boxer’s fracture with palmar angulation ≤70° and no rotational deformity. The fractures were treated by antegrade intramedullary Kirschner wiring; a single, prebent, 1.6-mm Kirschner wire was inserted into the medullary canal through the metacarpal base across the fracture into the metacarpal head with the proximal wire protruding percutaneously. The most important indication for reduction is the presence of malrotation, evaluated by physical examination. Metacarpal fracture treatment. When immobilized, athletes are encouraged to mobilize the uninjured fingers as well as the shoulder, elbow, and wrist to prevent stiffness. , In general, greater than 10° to 20° of angulation in the index finger and 40° in the small finger results in undesirable fingertip overlap and is an indication for operative treatment. Three-dimensional imaging, such as computed tomography (CT), usually is not necessary for simple or nondisplaced fractures; however, CT can be helpful for surgical planning for intra-articular or highly comminuted fractures. In general, most metacarpal fractures are stable and can be treated successfully nonoperatively. 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. These fixation options, however, don’t readily control rotation even with post-operative immobilization. Furthermore, the index and long finger metacarpals essentially are fixed at the CMC joints whereas the ring and small finger CMC joints allow for 15° to 25° of ring and small finger CMC joints, respectively. Philadelphia: WB Saunders, 1981:208-210. The presentation, diagnosis, and management of first (thumb) metacarpal fractures is reviewed here. , In addition to the stability from the bony articulation, the PIP joint has strong collateral ligaments that are taut throughout range of motion and a thick volar plate as well as the flexor and extensor tendons that contribute to stability. Reduction is not necessary for dorsal or volar angulation of < 35° for the 4th metacarpal < 45° for the 5th metacarpal. [13, 14, 15] Management usually consists of sedation or local anesthesia, followed by closed reduction of the fracture or dislocation. , , . Hand fractures: repair reconstruction and rehabilitation. A true lateral of the thumb is achieved with the hand pronated 30° and the beam angled 15° distally ( Fig. Metacarpal fractures: treatment and complications. Did you injure your little finger, and the pain just won't subside? The neck of a metacarpal is a common location for a boxer's fracture. Less commonly reported are stress fractures of the upper extremity; however, there are case series reporting metacarpal stress fractures in racket sport athletes and epiphyseal stress fractures of the phalanges in rock climbers. Treatment of metacarpal fractures and dislocations is primarily nonoperative. Conservative treatment of metacarpal fractures is recommended if there is no joint displacement, malrotation, displacement of over 30 degrees ad axim and shortening of over 5 mm. The fracture pattern should be described specifically, rather than using eponyms that can be misleading or misunderstood. Learn about its causes, symptoms, and treatment. 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. Treatment - Metacarpal Neck Fractures : Nonoperative. 4 ). Splinting is used in the initial immobilization of, and often is the definitive treatment for, metacarpal fractures. In the first few hours after an injury, a few first-aid techniques will aid in reducing the painful symptoms. 16. This study assess the long-term (> 5 years) outcomes of patients with metacarpal fractures who were surgically treated using bioabsorbable plates and screws (Super-Fixsorb MX40 mesh; Teijin Medical Technology, Osaka, Japan). 1. 41(3):451-461. . , The articular surface of the middle phalanx is biconcave with an intercondylar ridge, creating stability for the PIP joint. 5th metacarpal fractures can be treated in various ways depending on the nature of the fracture. For metacarpal neck fractures, intramedullary or trans-metacarpal K-wires are the mainstay of treatment to help control angulation and restore height. Edwards GS Jr, O'Brien ET, Heckman MM. A New Technique of Locked, Flexible Intramedullary Nailing of Spiral and Comminuted Fractures o... A Comparison of Locking Plates and Intramedullary Pinning for Fixation of Metacarpal Shaft Fractures. Not only are these opportunities at risk in the short term due to loss of playing time from injury recovery but also there is potential risk for long-term functional hand impairment after an athletic career. 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. The finger metacarpals articulate with the neighboring metacarpal proximally; they are attached to each other via strong interosseous ligaments and distally via the deep transverse metacarpal ligament ( Fig. Hand (N Y) 2014; 9:16. Hand fractures are the most common fractures sustained by children, and hand and wrist injuries account for up to 17% of sporting injuries in children. Fractures in this region are often comminuted, causing additional difficulty with their management. 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. 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. Carpometacarpal dislocations. Most people have fractures which are well-aligned, and, therefore, do not require surgery. 6 ) and then immobilized. The thumb metacarpal has a pronated position relative to the other metacarpals. The interossei insert onto the proximal phalanx whereas the central slip and terminal extensor tendon insert onto the middle phalanx and distal phalanx, respectively.
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