Metacarpal shaft 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 common. They account for up to 50 percent of all hand fractures [1,2]. Fractures of the metacarpal shaft are usually the result of direct or indirect trauma, but fatigue fractures can occur in athletes or as occupational injuries due to repetitive stress. The biomechanics, diagnosis, and treatment of stress fractures are presented separately. (See "Overview of stress fractures".)
This topic will review issues related to metacarpal shaft fractures. A general overview of metacarpal fractures and discussions of other common hand and wrist injuries are presented separately. (See "Overview of metacarpal fractures" and "Scaphoid fractures" and "Proximal phalanx fractures" and "Middle phalanx fractures" and "Distal phalanx fractures" and "Distal radius fractures in adults" and "Overview of carpal fractures" and "Evaluation of the adult with acute wrist pain".)
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 and figure 2 and figure 3). The functional importance of this configuration is that the metacarpal phalangeal (MCP) joints should be immobilized in flexion to prevent shortening of the collateral ligaments and subsequent loss of motion.
FRACTURE PATTERNS AND MECHANISM OF INJURY
Metacarpal shaft fractures occur in three basic patterns: transverse, oblique, and comminuted.
●Transverse fractures are caused by a direct blow. These fractures are typically pulled into apex dorsal angulation by the forces of the interosseous muscles (figure 4 and figure 5 and figure 6) and extrinsic flexor tendons exerted on the metacarpal shaft.
- Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23:19.
- Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26:908.
- Geissler WB. Operative fixation of metacarpal and phalangeal fractures in athletes. Hand Clin 2009; 25:409.
- Sahu A, Gujral SS, Batra S, et al. The current practice of the management of little finger metacarpal fractures--a review of the literature and results of a survey conducted among upper limb surgeons in the United Kingdom. Hand Surg 2012; 17:55.
- Soong M, Got C, Katarincic J. Ring and little finger metacarpal fractures: mechanisms, locations, and radiographic parameters. J Hand Surg Am 2010; 35:1256.
- Day CS, Stern PJ. Fractures of the Metacarpals and Phalanges. In: Green's Operative Hand Surgery, 6th, Wolfe SW et al.. (Ed), Elsevier, Philadelphia 2011. Vol One, p.245.
- Burkhalter WE. Closed treatment of hand fractures. J Hand Surg Am 1989; 14:390.
- Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg 2008; 16:586.
- 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.
- CLINICAL ANATOMY
- FRACTURE PATTERNS AND MECHANISM OF INJURY
- CLINICAL PRESENTATION AND EXAMINATION
- Assessment of hand alignment and function
- - Extensor apparatus
- - Angulation
- - Rotational alignment
- DIAGNOSTIC IMAGING
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR SURGICAL REFERRAL
- INITIAL TREATMENT
- CLOSED REDUCTION
- Performance of fracture reduction
- FOLLOW-UP CARE
- RETURN TO SPORT OR WORK
- PEDIATRIC CONSIDERATIONS
- SUMMARY AND RECOMMENDATIONS