First (thumb) 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 are among the most common hand injuries and frequently present to emergency departments and clinics. Fractures of the first metacarpal (ie, thumb metacarpal) comprise a substantial portion of these fractures.
The presentation, diagnosis, and management of first (thumb) metacarpal fractures is reviewed here. Other injuries of the thumb and surrounding tissues are discussed separately. (See "Evaluation of the patient with thumb pain" and "Scaphoid fractures" and "Ulnar collateral ligament injury (gamekeeper's or skier's thumb)" and "Overview of metacarpal fractures".)
Metacarpal fractures are common . They account for 30 to 40 percent of all hand fractures. First metacarpal (thumb) fractures make up almost 25 percent of all metacarpal fractures, placing them second only to fifth metacarpal neck (ie, "boxers") fractures in terms of frequency. Of the fractures of the first metacarpal, over 80 percent involve the base.
Thumb fractures overall occur most commonly in children under age 16 and adults over age 65, but thumb metacarpal fractures occur most often among younger males (10 to 29 years old) [2,3]. They are commonly caused by falls and direct trauma secondary to sports, bicycle accidents, and from punching solid objects [4-6]. (See "Evaluation of the patient with thumb pain".)
CLINICAL ANATOMY AND FRACTURE CLASSIFICATION
The thumb is distinct from the other fingers anatomically and biomechanically, and of critical importance to hand function. Accordingly, fractures to the thumb are considered separately from other metacarpal fractures, and must be managed with great care (see 'Management' below). Thumb anatomy is discussed in greater detail separately, but aspects of particular relevance to thumb metacarpal fractures is discussed here (see "Finger and thumb anatomy").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.
- Stanton JS, Dias JJ, Burke FD. Fractures of the tubular bones of the hand. J Hand Surg Eur Vol 2007; 32:626.
- Fufa DT, Goldfarb CA. Fractures of the thumb and finger metacarpals in athletes. Hand Clin 2012; 28:379.
- Cotterell IH, Richard MJ. Metacarpal and phalangeal fractures in athletes. Clin Sports Med 2015; 34:69.
- Carlsen BT, Moran SL. Thumb trauma: Bennett fractures, Rolando fractures, and ulnar collateral ligament injuries. J Hand Surg Am 2009; 34:945.
- Green DP, O'Brien ET. Fractures of the thumb metacarpal. South Med J 1972; 65:807.
- Foster RJ, Hastings H 2nd. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop Relat Res 1987; :121.
- 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.
- 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.
- Kozaci N, Ay MO, Akcimen M, et al. The effectiveness of bedside point-of-care ultrasonography in the diagnosis and management of metacarpal fractures. Am J Emerg Med 2015; 33:1468.
- Soyer AD. Fractures of the base of the first metacarpal: current treatment options. J Am Acad Orthop Surg 1999; 7:403.
- Burkhalter WE. Closed treatment of hand fractures. J Hand Surg Am 1989; 14:390.
- Eiff MP, Hatch R. Metacarpal fractures. In: Fracture Management for Primary Care, 3rd ed, updated edition, Elsevier Saunders, Philadelphia 2017.
- Stern PJ. Fractures of the metacarpals and phalanges: Fractures of the thumb. In: Green's Operative Hand Surgery, 5th ed, Green D, Hotchkiss R, Pederson WC (Eds), Churchill Livingstone, 2005. p.330.
- Ben-Amotz O, Sammer DM. Practical Management of Metacarpal Fractures. Plast Reconstr Surg 2015; 136:370e.
- Dang AC, Rodner CM. Unusual compression neuropathies of the forearm, part I: radial nerve. J Hand Surg Am 2009; 34:1906.
- Jacobson JA, Fessell DP, Lobo Lda G, Yang LJ. Entrapment neuropathies I: upper limb (carpal tunnel excluded). Semin Musculoskelet Radiol 2010; 14:473.
- Lanzetta M, Foucher G. Entrapment of the superficial branch of the radial nerve (Wartenberg's syndrome). A report of 52 cases. Int Orthop 1993; 17:342.
- CLINICAL ANATOMY AND FRACTURE CLASSIFICATION
- Metacarpal base fractures
- Metacarpal shaft, neck, and head fractures
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- DIAGNOSTIC IMAGING
- Plain radiographs
- Musculoskeletal ultrasound
- DIFFERENTIAL DIAGNOSIS
- INDICATIONS FOR SURGICAL REFERRAL
- Initial treatment
- - Intraarticular fractures
- - Extraarticular fractures
- - Pediatric first metacarpal fractures
- Closed reduction
- FOLLOW-UP CARE
- RETURN TO WORK OR SPORT
- SUMMARY AND RECOMMENDATIONS