Metacarpal neck fractures
- Josh Bloom, MD, MPH
Josh Bloom, MD, MPH
- Clinical Instructor, Department of Family Medicine
- University of North Carolina at Chapel Hill
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Chad A Asplund, MD, FACSM, MPH
Chad A Asplund, MD, FACSM, MPH
- Associate Professor of Health and Kinesiology
- Director of Athletic Medicine
- Head Team Physician
- Georgia Southern University
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Metacarpal fractures are common injuries that account for 30 to 40 percent of all hand fractures . Metacarpal neck fractures are the most common and are usually due to direct trauma. They most often involve the fifth and to a lesser degree, the fourth metacarpal neck. Fractures of the fifth metacarpal neck ("boxer's fractures") account for approximately 10 percent of all hand fractures.
This topic will review issues related to metacarpal neck fractures. A general overview of metacarpal fractures is presented separately. (See "Overview of metacarpal fractures".)
Finger anatomy is discussed in greater detail separately; items of particular relevance to metacarpal neck fractures are described here. (See "Finger and thumb anatomy".)
Metacarpals are often described using the numbers one through five. The first metacarpal refers to that associated with the thumb, the second to that associated with the index finger, and so on through the fifth metacarpal.
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).
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- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- Fracture angulation
- Rotational alignment
- Extensor apparatus
- Skin integrity
- RADIOGRAPHIC FINDINGS
- INDICATIONS FOR SURGICAL REFERRAL
- Initial treatment
- Closed reduction
- - Anesthesia
- - Reduction
- FOLLOW-UP CARE
- General follow-up
- Fifth metacarpal neck fractures
- RETURN TO WORK OR SPORT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS