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 — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Metacarpal fractures are among the most common hand injuries, and frequently present to emergency departments and clinics. Fractures of the metacarpal neck, including so-called "boxer's fractures" (fractures of the fifth metacarpal neck) account for a substantial percentage of all hand fractures.
The presentation, diagnosis, and management of metacarpal neck fractures is reviewed here. A general overview of metacarpal fractures and the management of other types of metacarpal fractures are discussed separately. (See "Overview of metacarpal fractures" and "Metacarpal shaft fractures" and "First (thumb) metacarpal fractures" and "Metacarpal base fractures" and "Metacarpal head fractures".)
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, typically involving young males [2,3]. In younger and older populations, falls are another common mechanism of injury. Metacarpal neck fractures 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.
Finger and metacarpal anatomy are reviewed in greater detail separately; items of particular relevance to metacarpal neck fractures are discussed below. (See "Finger and thumb anatomy" and "Overview of metacarpal fractures", section on '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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23:19.
- Nakashian MN, Pointer L, Owens BD, Wolf JM. Incidence of metacarpal fractures in the US population. Hand (N Y) 2012; 7:426.
- de Jonge JJ, Kingma J, van der Lei B, Klasen HJ. Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury 1994; 25:365.
- Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y) 2014; 9:16.
- Jones NF, Jupiter JB, Lalonde DH. Common fractures and dislocations of the hand. Plast Reconstr Surg 2012; 130:722e.
- Cotterell IH, Richard MJ. Metacarpal and phalangeal fractures in athletes. Clin Sports Med 2015; 34:69.
- Tayal VS, Antoniazzi J, Pariyadath M, Norton HJ. Prospective use of ultrasound imaging to detect bony hand injuries in adults. J Ultrasound Med 2007; 26:1143.
- Neri E, Barbi E, Rabach I, et al. Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients. Arch Dis Child 2014; 99:1087.
- Kocaoğlu S, Özhasenekler A, İçme F, et al. The role of ultrasonography in the diagnosis of metacarpal fractures. Am J Emerg Med 2016; 34:1868.
- Lamraski G, Monsaert A, De Maeseneer M, Haentjens P. Reliability and validity of plain radiographs to assess angulation of small finger metacarpal neck fractures: human cadaveric study. J Orthop Res 2006; 24:37.
- Henry MH. Fractures and dislocations of the hand. In: Rockwood and Green's fractures in adults, 6th edition, Bucholz RW, Heckman JD, Court-Brown C (Eds), Lippincott, Williams & Wilkins, Philadelphia 2006. p.772.
- Fufa DT, Goldfarb CA. Fractures of the thumb and finger metacarpals in athletes. Hand Clin 2012; 28:379.
- Statius Muller MG, Poolman RW, van Hoogstraten MJ, Steller EP. Immediate mobilization gives good results in boxer's fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg 2003; 123:534.
- Birndorf MS, Daley R, Greenwald DP. Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg 1997; 99:1079.
- Ali A, Hamman J, Mass DP. The biomechanical effects of angulated boxer's fractures. J Hand Surg Am 1999; 24:835.
- Low CK, Wong HC, Low YP, Wong HP. A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers. J Hand Surg Br 1995; 20:609.
- Burkhalter WE. Closed treatment of hand fractures. J Hand Surg Am 1989; 14:390.
- Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am 2013; 38:1021.
- Tavassoli J, Ruland RT, Hogan CJ, Cannon DL. Three cast techniques for the treatment of extra-articular metacarpal fractures. Comparison of short-term outcomes and final fracture alignments. J Bone Joint Surg Am 2005; 87:2196.
- Poolman RW, Goslings JC, Lee JB, et al. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev 2005; :CD003210.
- Davison PG, Boudreau N, Burrows R, et al. Forearm-Based Ulnar Gutter versus Hand-Based Thermoplastic Splint for Pediatric Metacarpal Neck Fractures: A Blinded, Randomized Trial. Plast Reconstr Surg 2016; 137:908.
- Dunn JC, Kusnezov N, Orr JD, et al. The Boxer's Fracture: Splint Immobilization Is Not Necessary. Orthopedics 2016; 39:188.
- van Aaken J, Fusetti C, Luchina S, et al. Fifth metacarpal neck fractures treated with soft wrap/buddy taping compared to reduction and casting: results of a prospective, multicenter, randomized trial. Arch Orthop Trauma Surg 2016; 136:135.
- Braakman M, Oderwald EE, Haentjens MH. Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury 1998; 29:5.
- Harding IJ, Parry D, Barrington RL. The use of a moulded metacarpal brace versus neighbour strapping for fractures of the little finger metacarpal neck. J Hand Surg Br 2001; 26:261.
- Kuokkanen HO, Mulari-Keränen SK, Niskanen RO, et al. Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting. Scand J Plast Reconstr Surg Hand Surg 1999; 33:315.
- Hofmeister EP, Kim J, Shin AY. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. J Hand Surg Am 2008; 33:1362.
- Dolan RT, Al Khudairy A, Mc Kenna P, et al. The upper hand on compartment syndrome. Am J Emerg Med 2012; 30:2084.e7.
- CLINICAL ANATOMY
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- Presentation and general findings
- Fracture angulation
- Rotational alignment
- Extensor apparatus
- Skin integrity
- DIAGNOSTIC IMAGING
- DIFFERENTIAL DIAGNOSIS
- Hand contusion
- Metacarpal phalangeal dislocation
- INDICATIONS FOR SURGICAL REFERRAL
- Initial treatment
- Closed reduction
- - Anesthesia
- - Reduction
- Delayed presentation
- FOLLOW-UP CARE
- General follow-up
- Fifth metacarpal neck fractures
- RETURN TO WORK OR SPORT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS