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.
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- 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