Metacarpal Fractures



1.  Neck of 5th Metacarpal

2.  Metacarpal Shaft

3.  Metacarpal Head

4.  Base of Metacarpal Fracture Dislocations

5.  Base of Thumb Fractures / Bennett's / Rolanda


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


Neck of Fifth Metacarpal Fracture


Operative Treatment



- 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


Metacarpal Fracture Minimally Displaced


Operative Management



- plate

- lag screws (if spiral fracture)

- intramedullary wires


Metacarpal Intramedullary Wires


3.  Metacarpal Head Fracture



- uncommon

- usually in index finger


Indication for surgery

- > 2mm angulation



- T plate

- headless compression screws / intra-articular


4.  Base of Metacarpal Fracture Dislocations


Can be missed

- may need CT to diagnose



- reduce joint closed +/- open 

- dorsal approach

- K wire


Metacarpal Base Fracture Dislocation APMetacarpal Base Fracture Dislocation LateralBase of Metacarpal Dislocation CT


5.  Base of Thumb Metacarpal



A.  Bennett's

B.  Rolando

- Y shaped intra-articular


A.  Bennett's Fracture


Bennetts Fracture APBennetts Fracture LateralBennetts CT



- oblique intra-articular fracture

- small volar fragment remains in situ as attached to beak ligament

- metacarpal displaces proximally and dorsally due to APL

- inherently unstable



- closed reduction

- longitudinal traction on metacarpal

- use thumb to reduce metacarpal shaft

- use 2 x K wires to pin metacarpal to trapezium / trapezoid

- 6 weeks in thumb spica cast


Bennetts FractureBennetts K wireBennetts ORIF


Bennett K wires


B.  Rolando Fracture



- 2 small intra-articular fragments

- poor prognosis


Operative management

- for significant displacement

- dorsal approach

- protect superficial radial nerves

- between APL / EPB and EPL

- attempt to anatomically reduce and fix with plate