Metacarpal Fracture and Dislocation Clinical Presentation
- Author: David R Steinberg, MD; Chief Editor: Craig C Young, MD more...
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- The patient with a metacarpal fracture or CMC dislocation presents with dorsal hand pain and swelling.
- Patients may report having limited motion in their fingers because of pain and/or deformity.
- Paresthesias are rare, unless they are associated with severe soft-tissue injury, as is seen with multiple metacarpal fractures or with high-energy crushing injuries.
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- Physical examination in a patient with suspected metacarpal fracture and/or dislocation may reveal diffuse swelling and ecchymosis of the entire dorsal aspect of the hand, or findings may be limited over the involved bone.
- Tenderness and crepitus can be palpated at the fracture site.
- The prominence of the metacarpal head is decreased, with apex dorsal angulation of the fracture due to the pull of the intrinsic muscles.
- Look for a possible malrotation, which is easily missed on radiographs.
- The nails should be coplanar when the fingers are in extension, and all fingers should point toward the scaphoid tubercle in flexion.
- Finger crossover (scissoring) during flexion indicates a malrotation.
- As with any evaluation of the upper extremity, the neurovascular status should be documented.
- The skin should be evaluated for lacerations or puncture wounds, which suggest an open fracture.
Related Medscape topics:
Resource Center Vascular Surgery
Specialty Site Neurology & Neurosurgery
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- A sudden, forceful axial load or direct trauma can lead to transverse fractures of the metacarpal neck or shaft, as well as CMC fracture-dislocations.
- Torsional forces may produce spiral or oblique fractures of shaft. These injuries are most likely to be associated with a rotational deformity.
- A clenched-fist injury is commonly associated with metacarpal neck fractures ("boxer fractures"). The usual mechanism is punching a wall or an assailant (often in the mouth).
- High-energy crush injuries (which are rarely seen in sporting activities) lead to associated soft-tissue damage and often involve multiple metacarpal fractures.
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