Fractures
1. Neck of 5th Metacarpal
2. Metacarpal Shaft
3. Metacarpal Head
4. Base of Metacarpal Fracture Dislocations
5. MCPJ dislocations
1. Neck of 5th Metacarpal Fracture
Non operative Management
Accept 45o angulation
- will have finger extensor lag, but will recover
- can ring block and manipulate in POSI cast to improve position
Operative Treatment
Rare
- K wire across MC head into 4th MC
2. Metacarpal Shaft Fracture
Acceptable Deformity
Rotation < 5o
10o / 20o / 30o / 40o in IF / MF / RF / LF
< 5 mm shortening
Operative Management
Options
- plate
- lag screws (if spiral fracture)
- intramedullary wires
3. Metacarpal Head Fracture
Epidemiology
- uncommon
- usually in index finger
Indication for surgery
- > 2mm angulation
Options
- T plate
- headless compression screws / intra-articular
4. Base of Metacarpal Fracture Dislocations
Can be missed
- may need CT to diagnose
Management
- reduce joint closed +/- open
- dorsal approach
- K wire
5. MCPJ Dislocation
Simple
- volar plate not interposed
- MCPJ 90o hyper-extended
- reduce via wrist flexion and volar translation of PP
- avoid hyperextension and axial distraction which may convert this injury to a complex dislocation
- extension blocking splint 3-4 weeks
Complex
- volar plate / lumbrical tendon / flexor tendons interposed
- joint space widened
- requires open reduction, dorsal or volar
- volar more direct but risk NV bundles
- protected motion post operatively