eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Metacarpal Fractures: Workup

Author: T Michael Dye, MD, Orthopedic Surgeon, Surgical Critical Care Element Chief, Department of Orthopedic Surgery, Eglin Air Force Base
Contributor Information and Disclosures

Updated: Sep 2, 2009

Workup

Imaging Studies


AP radiograph of displaced 4th and 5th metacarpal...

AP radiograph of displaced 4th and 5th metacarpal fractures.

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AP radiograph of displaced 4th and 5th metacarpal...

AP radiograph of displaced 4th and 5th metacarpal fractures.



Lateral radiograph of displaced 4th and 5th metac...

Lateral radiograph of displaced 4th and 5th metacarpal fractures.

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Lateral radiograph of displaced 4th and 5th metac...

Lateral radiograph of displaced 4th and 5th metacarpal fractures.



Oblique radiograph of 4th and 5th metacarpal frac...

Oblique radiograph of 4th and 5th metacarpal fractures.

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Oblique radiograph of 4th and 5th metacarpal frac...

Oblique radiograph of 4th and 5th metacarpal fractures.



AP radiograph of 4th and 5th metacarpal fractures...

AP radiograph of 4th and 5th metacarpal fractures following intramedullary pinning.

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AP radiograph of 4th and 5th metacarpal fractures...

AP radiograph of 4th and 5th metacarpal fractures following intramedullary pinning.



Lateral radiograph of 4th and 5th metacarpals fol...

Lateral radiograph of 4th and 5th metacarpals following intramedullary pinning.

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Lateral radiograph of 4th and 5th metacarpals fol...

Lateral radiograph of 4th and 5th metacarpals following intramedullary pinning.


  • Plain radiography is the primary means of evaluating hand injuries beyond the history and physical examination. Any significant injury to the hand should be assessed with posteroanterior (PA), lateral, and oblique views. A 30° pronated lateral view for 2nd and 3rd metacarpal fractures and a 30° supinated lateral view for 4th and 5th metacarpal fractures are helpful.9,10
    • Carpometacarpal injuries
      • CMC fractures and dislocations are frequently difficult to visualize or fully characterize with standard radiographic projections. Additional oblique views, fluoroscopy, or computed tomography may be necessary. Additionally, traction radiographs can sometimes best demonstrate the bony and ligamentous injuries and their severity. This is accomplished by distracting the involved digits and obtaining multiple radiographic views.
      • CMC dislocation results in subtle loss of joint space as viewed on the anteroposterior (AP) projection. Often, this is seen as a broken sawtooth sign at the CMC joint. This sign may be accompanied by displacement noted on lateral or oblique views.
      • Assessing closely for other additional injuries is important. Because significant force is required to disrupt the strong CMC ligaments, fracture-dislocation of one CMC joint is often accompanied by an injury to one or more of its neighbors.
  • Metacarpal head fractures
    • Evaluation of these injuries may require additional imaging studies. Specifically, tomograms or CT scans may be necessary to visualize the fracture and degree of articular displacement.
    • The Brewerton view (MCP joint flexed 65° with the dorsum of the proximal phalanx flat against the radiograph cassette and the beam angled 15° ulnar to radial) profiles the collateral recesses and is helpful for collateral ligament avulsion fractures.
  • Metacarpophalangeal dislocations
    • Most commonly, lateral radiographs reveal the dorsal displacement of the proximal phalanx.
    • In more severe and complex dislocations, there may also coexist a metacarpal head fracture.

More on Metacarpal Fractures

Overview: Metacarpal Fractures
Workup: Metacarpal Fractures
Treatment: Metacarpal Fractures
Follow-up: Metacarpal Fractures
Multimedia: Metacarpal Fractures
References
Further Reading
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References

  1. Ozer K, Gillani S, Williams A, Peterson SL, Morgan S. Comparison of intramedullary nailing versus plate-screw fixation of extra-articular metacarpal fractures. J Hand Surg Am. Dec 2008;33(10):1724-31. [Medline].

  2. Harris AR, Beckenbaugh RD, Nettrour JF, Rizzo M. Metacarpal neck fractures: results of treatment with traction reduction and cast immobilization. Hand (N Y). Jun 2009;4(2):161-4. [Medline].

  3. Liporace FA, Kinchelow T, Gupta S, Kubiak EN, McDonnell M. Minifragment screw fixation of oblique metacarpal fractures: a biomechanical analysis of screw types and techniques. Hand (N Y). Dec 2008;3(4):311-5. [Medline].

  4. Souer JS, Mudgal CS. Plate fixation in closed ipsilateral multiple metacarpal fractures. J Hand Surg Eur Vol. Dec 2008;33(6):740-4. [Medline].

  5. Ashkenaze DM, Ruby LK. Metacarpal fractures and dislocations. Orthop Clin North Am. Jan 1992;23(1):19-33. [Medline].

  6. Axelrod TS. Metacarpal Fractures. Hand Surgery Update 2. 1999:11-17.

  7. de Jonge JJ, Kingma J, van der Lei B. Fractures of the metacarpals. A retrospective analysis of incidence and etiology and a review of the English-language literature. Injury. Aug 1994;25(6):365-9. [Medline].

  8. Green DP, Butler TE. Fractures and dislocations in the hand. In: Rockwood and Green's Fractures in Adults. Vol 1. 4th ed. 1996:607-744.

  9. Westbrook AP, Davis TR. An evaluation of a clinical method to assess malunion of little finger metacarpal fractures. J Hand Surg Eur Vol. Dec 2007;32(6):641-6. [Medline].

  10. 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. Oct 2005;87(10):2196-201. [Medline].

  11. Chin SH, Vedder NB. MOC-PSSM CME article: Metacarpal fractures. Plast Reconstr Surg. Jan 2008;121(1 Suppl):1-13. [Medline].

  12. Al-Qattan MM, Al-Lazzam A. Long oblique/spiral mid-shaft metacarpal fractures of the fingers: treatment with cerclage wire fixation and immediate post-operative finger mobilisation in a wrist splint. J Hand Surg Eur Vol. Dec 2007;32(6):637-40. [Medline].

  13. Drelich M, Godlewski P. Metacarpal fractures. Ortop Traumatol Rehabil. Jun 30 2004;6(3):331-5. [Medline].

  14. Cornwall R. Finger metacarpal fractures and dislocations in children. Hand Clin. Feb 2006;22(1):1-10. [Medline].

  15. Tun S, Sekiya JK, Goldstein SA, Jebson PJ. A comparative study of mini-external fixation systems used to treat unstable metacarpal fractures. Am J Orthop. Sep 2004;33(9):433-8. [Medline].

  16. Galanakis I, Aligizakis A, Katonis P, Papadokostakis G, Stergiopoulos K, Hadjipavlou A. Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires. J Trauma. Sep 2003;55(3):509-13. [Medline].

  17. Jhass S. Fractures of the metacarpals - a new method of reduction and immobilization. J Bone Joint Surg. 1938;20 (1):178-186.

  18. Dumont C, Fuchs M, Burchhardt H, Appelt D, Bohr S, Stürmer KM. Clinical results of absorbable plates for displaced metacarpal fractures. J Hand Surg [Am]. Apr 2007;32(4):491-6. [Medline].

  19. Kurup HV. Re: Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Eur Vol. Jun 2007;32(3):363; author reply 363-4. [Medline].

  20. Downing ND, Davis TR. Intramedullary fixation of unstable metacarpal fractures. Hand Clin. Aug 2006;22(3):269-77. [Medline].

  21. Fusetti C, Meyer H, Borisch N, Stern R, Santa DD, Papaloïzos M. Complications of plate fixation in metacarpal fractures. J Trauma. Mar 2002;52(3):535-9. [Medline].

  22. Maruyama T, Saha S, Mongiano DO. Metacarpal fracture fixation with absorbable polyglycolide rods and stainless steel K wires: a biomechanical comparison. J Biomed Mater Res. Spring 1996;33(1):9-12. [Medline].

  23. Stern PJ. Fractures of the metacarpals and phalanges. In: Green's Operative Hand Surgery. Vol 1. 4th ed. 1999:711-71.

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Keywords

metacarpal fracture, boxer's fracture, Bennett fracture, reverse Bennett's fracture, carpometacarpal dislocation, metacarpophalangeal dislocation

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Contributor Information and Disclosures

Author

T Michael Dye, MD, Orthopedic Surgeon, Surgical Critical Care Element Chief, Department of Orthopedic Surgery, Eglin Air Force Base
T Michael Dye, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, and Special Operations Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Michael S Clarke, MD, Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine
Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

N Ake Nystrom, MD, PhD, Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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