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Metacarpal neck fractures

Josh Bloom, MD, MPH
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Metacarpal fractures are common injuries that account for 30 to 40 percent of all hand fractures [1]. 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).


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Literature review current through: Jul 2017. | This topic last updated: Oct 01, 2015.
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