Metacarpal Neck Fracture S62.339A 815.04

Metacarpal neck fracture xray

CRPP metacarpal neck fracture xray

Metacarpal fracture malunion photo

Metacarpal neck fracture nonunion xray

synonyms: Boxer's fracture

Metacarpal Neck Fracture ICD-10

Metacarpal Neck Fracture ICD-9

  • 815.04(closed),
  • 815.14(open)

Metacarpal Neck Fracture Etiology / Epidemiology / Natural History

  • Angulation >30 degrees, shortening >4mm or rotation 5° can lead to grip weakness, loss of endurance, cramping, clawing or an abnormal cascade..
  • Unreduced apex dorsal angualtion >30° leads to a loss of the MCP joint prominence on the dorsum of the hand
  • Any rotational deformity can lead to digital overlap during finger flexion

Metacarpal Neck Fracture Anatomy

Metacarpal Neck Fracture Clinical Evaluation

  • Generally have obvious pain and deformity at the fracture site.
  • Document neurovascular status of the finger before and after any reduction.
  • Evaluate cascade, any scissoring or overlap indicates need for reduction +/- fixation

Metacarpal Neck Fracture Xray / Diagnositc Tests

  • P/A and lateralviews of hand
  • 30-45 degree suppinated or pronated views

Metacarpal Neck Fracture Classification / Treatment

  • Small finger apex dorsal angulation <50°: cast /splint with buddy tape
  • Small finger apex dorsal angluation >50°: closed reduction with ORIF vs CRPP if unstable.
  • Ring Finger apex dorsal angulation <30°: cast / splint with buddy tape
  • Ring finger apex dorsal angultion >30°: closed reduction with ORIF vs CRPP if unstable.
  • MIddle finger apex dorsal angulation <15°: cast / splint with buddy tape
  • Middle finger apex dorsal anglgutlaiton >15: closed reduction with ORIF vs CRPP if unstable.
  • Index finger apex dorsal angulation < 10°: cast / splint with buddy tape
  • Index finger apex dorsal angulation >10°: closed reduction with ORIF vs CRPP if unstable.
  • Open fracture: consider mini-external fixation. (Freeeland AE, CORR, 1987;214:93)
  • Jahss Reduction Maneuver: MCP joint flexed 70-90 degrees. Proximal fragment is compressed in a palmar direction while the metacarpal head is pushed dorsally. (Jahss SA, JBJS 1938;20:178).
  • Casting technique: position of the MCP joints and the absence or presence of interphalangeal joint motion during casting has little effect on motion, grip strength, or fracture alignment (Tavassoli J, JBJS 2005;87A:2196).

Metacarpal Neck Fracture Associated Injuries / Differential Diagnosis

  • Fight bite
  • Fracture / dislocation of adjacent metacarpal at carpometacarpal joint

Metacarpal Neck Fracture Complications

  • Cosmetic deformity
  • Nonunion
  • Stiffness / tendon adhesions
  • Hardware failure
  • Complex regional pain syndrome
  • Infection

CRPP Complications=delayed union, malunion, pin tract infection, migration, wire breakage

Metacarpal Neck Fracture Follow-up Care

  • Post-op: Splint in "safe" position (wrist extended 15-20 degrees, MCP joints flexed 70 degrees, PIP joint in 0-10 degrees flexion)
  • 7-10 Days: remove splint. Place in removable splint with fingers buddy-taped. Encourage gentle ROM
  • 6 Weeks: Check xrays. Progress with ROM exercises. Activity modifications: no heavy manual labor, no contact sports, no lifting >5 lbs.
  • 3 Months: Check xrays. If union is complete return to full activities. Assess motion, consider occupational therapy if indicated.
  • 6 Months: Assess motion,
  • 1Yr: F/u xrays, assess outcome

Metacarpal Neck Fracture Review References

  • Rockwood and Greens
  • Greens Hand Surgery
  • Freeland AE, Geissler WB, Weiss AP, Operative Treatment of Common Displaced and Unstable Fractures of the Hand, JBJS 2001;83A:928-945
  • Freeland AE, Orbay JL. ORIF of the Tubular Bones of the Hand In: Stickland JW, Grahma TJ, editor. Hand 2nd ed. Master Techniques in orthopedic surgery. Philadeplhia: Lippincott-Raven; 2004. p 3