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 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. They 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.
This topic will review issues related to metacarpal neck fractures. A general overview of metacarpal fractures is presented separately. (See "Overview of metacarpal fractures".)
Finger anatomy is discussed in greater detail separately; items of particular relevance to metacarpal neck fractures are described here. (See "Finger and thumb 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.
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).
- Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am 1992; 23:19.
- 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.
- 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.
- 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.
- 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.
- MECHANISM OF INJURY
- SYMPTOMS AND EXAMINATION FINDINGS
- Fracture angulation
- Rotational alignment
- Extensor apparatus
- Skin integrity
- RADIOGRAPHIC FINDINGS
- INDICATIONS FOR SURGICAL REFERRAL
- Initial treatment
- Closed reduction
- - Anesthesia
- - Reduction
- FOLLOW-UP CARE
- General follow-up
- Fifth metacarpal neck fractures
- RETURN TO WORK OR SPORT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS