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Metacarpal Fractures Workup

  • Author: Thomas Michael Dye, MD; Chief Editor: Harris Gellman, MD  more...
 
Updated: Aug 24, 2015
 

Plain Radiography

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 second and third metacarpal fractures and a 30° supinated lateral view for fourth and fifth metacarpal fractures are helpful.[11, 12] (See the images below.)

AP radiograph of displaced 4th and 5th metacarpal AP radiograph of displaced 4th and 5th metacarpal fractures.
Lateral radiograph of displaced 4th and 5th metaca Lateral radiograph of displaced 4th and 5th metacarpal fractures.
Oblique radiograph of 4th and 5th metacarpal fract 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.
Lateral radiograph of 4th and 5th metacarpals foll Lateral radiograph of 4th and 5th metacarpals following intramedullary pinning.

Carpometacarpal injuries

Carpometacarpal (CMC) fractures and dislocations are frequently difficult to visualize or fully characterize with standard radiographic projections. Additional oblique views, fluoroscopy, or computed tomography (CT) 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 (metacarpophalangeal [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.

 
 
Contributor Information and Disclosures
Author

Thomas Michael Dye, MD Orthopedic Surgeon, Shawnee Medical Center

Thomas Michael Dye, MD is a member of the following medical societies: Alpha Omega Alpha, Special Operations Medical Association, American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

N Ake Nystrom, MD, PhD Associate Professor of Orthopedic Surgery and Plastic Surgery, University of Nebraska Medical Center

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, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern 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, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Arthroscopy Association of North America, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, Missouri State Medical Association

Disclosure: Nothing to disclose.

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AP radiograph of displaced 4th and 5th metacarpal fractures.
Lateral radiograph of displaced 4th and 5th metacarpal fractures.
Oblique 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 following intramedullary pinning.
Complex 2nd metacarpophalangeal (MCP) dislocation in skeletally immature patient; note position of finger and dimpling of skin on volar hand.
Radiograph of complex 2nd metacarpophalangeal (MCP) dislocation in skeletally immature patient (same patient as in Image 6).
 
 
 
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