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Overview of metacarpal fractures

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

INTRODUCTION

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".)

CLASSIFICATION

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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Literature review current through: Nov 2017. | This topic last updated: Sep 26, 2017.
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References
Top
  1. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y) 2014; 9:16.
  2. Meals C, Meals R. Hand fractures: a review of current treatment strategies. J Hand Surg Am 2013; 38:1021.
  3. Cotterell IH, Richard MJ. Metacarpal and phalangeal fractures in athletes. Clin Sports Med 2015; 34:69.
  4. Neumeister MW, Webb K, McKenna K. Non-surgical management of metacarpal fractures. Clin Plast Surg 2014; 41:451.
  5. Bloom JM, Hammert WC. Evidence-based medicine: Metacarpal fractures. Plast Reconstr Surg 2014; 133:1252.
  6. Ben-Amotz O, Sammer DM. Practical Management of Metacarpal Fractures. Plast Reconstr Surg 2015; 136:370e.
  7. 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.
  8. Braakman M, Oderwald EE, Haentjens MH. Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury 1998; 29:5.
  9. 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.
  10. 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.
  11. 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.
  12. Poolman RW, Goslings JC, Lee JB, et al. Conservative treatment for closed fifth (small finger) metacarpal neck fractures. Cochrane Database Syst Rev 2005; :CD003210.
  13. Kodama N, Takemura Y, Ueba H, et al. Operative treatment of metacarpal and phalangeal fractures in athletes: early return to play. J Orthop Sci 2014; 19:729.
  14. Freeland AE, Orbay JL. Extraarticular hand fractures in adults: a review of new developments. Clin Orthop Relat Res 2006; 445:133.
  15. Jones NF, Jupiter JB, Lalonde DH. Common fractures and dislocations of the hand. Plast Reconstr Surg 2012; 130:722e.