Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Metacarpal head fractures

INTRODUCTION

Metacarpal fractures are common injuries [1]. They account for 30 to 40 percent of all hand fractures. This topic will review issues related to metacarpal head fractures, which are usually the result of direct trauma.

This topic will review issues related to metacarpal head fractures. A general overview of metacarpal fractures is presented separately. (See "Overview of metacarpal fractures".)

PERTINENT ANATOMY

Metacarpal heads articulate with their corresponding phalanx. Thus, a fracture of the head is, by definition, an intraarticular fracture. The heads of the metacarpals are bulbous and "cam" shaped, thereby permitting adduction, abduction, flexion, extension and passive rotation of the fingers. The collateral ligaments join the metacarpal to the proximal phalanx and are taut in flexion, while having some laxity in extension (figure 1).

MECHANISM OF INJURY

Fractures of the metacarpal heads are relatively rare and usually result from a direct blow, crush, or missile injury. The second metacarpal (ray of index finger) is most commonly involved, and the first metacarpal head (ray of thumb) is rarely fractured. In some patients, rupture of the collateral ligaments by torsional valgus or varus stress can result in avulsion fractures at the metacarpal head.

SYMPTOMS AND EXAMINATION FINDINGS

Prominent swelling, decreased range of motion, and tenderness is found at the metacarpophalangeal (MCP) joint. Axial load to the MCP joint worsens pain.

        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2014. | This topic last updated: May 13, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.