Overview of metacarpal 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 account for 30 to 40 percent of all hand fractures. These fractures are usually the result of direct 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".)
Splinting is used in the initial immobilization of, and often is the definitive treatment for, metacarpal fractures. A detailed description of the techniques for applying splints is presented separately. (See "Basic techniques for splinting of musculoskeletal injuries".)
This topic will provide an overview of the classification, anatomy, examination, and general management principles of metacarpal fractures. More detailed discussions of specific fractures are presented separately. (See "Metacarpal shaft fractures" and "Metacarpal neck fractures" and "First (thumb) metacarpal fractures" and "Metacarpal base fractures" and "Metacarpal head fractures".)
Overview — Metacarpal fractures are classified anatomically. Fractures of the second, third, fourth, and fifth metacarpals are subdivided into those affecting the metacarpal head, neck, shaft, or base. Due to the unique biomechanics and anatomy of the thumb, fractures of the first metacarpal are classified separately. (See "First (thumb) metacarpal fractures".)
Metacarpal fractures are further described by the degree of displacement, angulation, shortening, rotation, and by the fracture type (transverse, oblique, spiral, comminuted, impacted, or avulsion (figure 1)). The metacarpal neck and shaft are the most common sites for fractures of the second through fifth metacarpals, while the first (thumb) metacarpal is usually fractured at the base. A more detailed discussion of how fractures are categorized and how to describe radiographs of fractures is provided separately. (See "General principles of fracture management: Bone healing and fracture description", section on 'Fracture description'.)
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