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Metacarpal Fracture and Dislocation Clinical Presentation

  • Author: David R Steinberg, MD; Chief Editor: Craig C Young, MD  more...
 
Updated: Mar 10, 2015
 

History

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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

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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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Causes

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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.[6]
  • A clenched-fist injury is commonly associated with metacarpal neck fractures ("boxer fractures").[7] 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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Contributor Information and Disclosures
Author

David R Steinberg, MD Director of Hand Fellowship, Associate Professor, Department of Orthopedic Surgery, University of Pennsylvania Health System

David R Steinberg, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand

Disclosure: Received nothing received, but have long-term ownership of public equities from Johnson & Johnson for none.

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.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Gerard A Malanga, MD Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Institute of Ultrasound in Medicine, North American Spine Society, International Spine Intervention Society, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine

Disclosure: Received honoraria from Cephalon for speaking and teaching; Received honoraria from Endo for speaking and teaching; Received honoraria from Genzyme for speaking and teaching; Received honoraria from Prostakan for speaking and teaching; Received consulting fee from Pfizer for speaking and teaching.

References
  1. Lambotte A. The Classic. Contribution to conservative surgery of the injured hand. By Dr. A. Lambotte. 1928. Clin Orthop Relat Res. 1987 Jan. 214:4-6. [Medline].

  2. Stern PJ. Fractures of the metacarpals and phalanges. Green DP, Hotchkiss RN, Pederson WC, eds. Green’s Operative Hand Surgery. 4th ed. New York, NY: Churchill Livingstone; 1999. 711-71.

  3. EMMETT JE, BRECK LW. A review and analysis of 11,000 fractures seen in a private practice of orthopaedic surgery, 1937-1956. J Bone Joint Surg Am. 1958 Oct. 40-A(5):1169-75. [Medline]. [Full Text].

  4. Gaheer RS, Ferdinand RD. Fracture dislocation of carpometacarpal joints: a missed injury. Orthopedics. 2011 May 18. 34(5):399. [Medline].

  5. Brownlie C, Anderson D. Bennett fracture dislocation - review and management. Aust Fam Physician. 2011 Jun. 40(6):394-6. [Medline].

  6. Weckesser EC. Rotational osteotomy of the metacarpal for overlapping fingers. J Bone Joint Surg Am. 1965 Jun. 47:751-6. [Medline]. [Full Text].

  7. Yoshida R, Shah MA, Patterson RM, Buford WL Jr, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg [Am]. 2003 Nov. 28(6):1035-43. [Medline].

  8. Lane CS. Detecting occult fractures of the metacarpal head: the Brewerton view. J Hand Surg [Am]. 1977 Mar. 2(2):131-3. [Medline].

  9. Gedda KO, Moberg E. Open reduction and osteosynthesis of the so-called Bennett's fracture in the carpo-metacarpal joint of the thumb. Acta Orthop Scand. 1953. 22(3):249-57. [Medline].

  10. Livesley PJ. The conservative management of Bennett's fracture-dislocation: a 26-year follow-up. J Hand Surg [Br]. 1990 Aug. 15(3):291-4. [Medline].

  11. Chong AK, Chew WY. An isolated ring finger metacarpal shaft fracture?--beware an associated little finger carpometacarpal joint dislocation. J Hand Surg [Br]. 2004 Dec. 29(6):629-31. [Medline].

  12. Bora FW Jr, Didizian NH. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg Am. 1974 Oct. 56(7):1459-63. [Medline]. [Full Text].

  13. Moon SJ, Yang JW, Roh SY, Lee DC, Kim JS. Comparison between Intramedullary Nailing and Percutaneous K-Wire Fixation for Fractures in the Distal Third of the Metacarpal Bone. Arch Plast Surg. 2014 Nov. 41(6):768-72. [Medline]. [Full Text].

  14. Burton RI, Eaton RG. Common hand injuries in the athlete. Orthop Clin North Am. 1973 Jul. 4(3):809-38. [Medline].

  15. Burkhalter WE. Closed treatment of hand fractures. J Hand Surg [Am]. 1989 Mar. 14(2 pt 2):390-3. [Medline].

  16. Jahss SA. Fractures of the metacarpals: a new method of reduction and immobilization. J Bone Joint Surg Am. 1938. 20:178-86. [Full Text].

  17. Ker HR. Dislocation of the fifth carpometacarpal joint. J Bone Joint Surg Br. 1955 May. 37-B(2):254-6. [Medline]. [Full Text].

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