Metacarpal Fractures: Anatomy, Injuries and Treatment-Case: Metacarpal Fracture

Case: Metacarpal Fracture

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Case 1 describes a 20-year-old man who presents with pain and swelling in his thumb after a skiing injury. Examination reveals swelling and tenderness at the base of the thumb. X-rays show a Bennett fracture of the thumb carpometacarpal joint, which is an intra-articular fracture-dislocation of the thumb metacarpal base. The main goal of treatment for this fracture is to obtain and maintain an anatomical reduction of the joint surface. Surgical treatment is generally recommended for Bennett fractures, with reduction of the thumb metacarpal maintained by surgical fixation. Thumb pronation is also important for anatomic reduction of the metacarpal to the ulnar fragment. Open reduction is indicated when there is greater than 2 mm of articular step-off after closed reduction. The smaller fragment is usually stable and does not require fixation. Fluoroscopy may underestimate fracture displacement, so arthroscopy or direct visualization may be utilized during surgical fixation.<br /><br />Case 2 involves a 56-year-old man who sustains a crush injury to his hand at work. He presents to the emergency room with an open wound on the dorsal hand. Metacarpal shaft fractures can be treated with closed, percutaneous, or open techniques. Fractures with stable patterns, without rotational deformity or shortening, can be treated with simple immobilization. Indications for operative management include rotational malalignment, multiple fractures, shortening greater than 2-5 mm, angulation, and intraarticular injuries. Non-operative treatment has the fewest complications. Complications after open reduction and plate fixation are frequent, including difficulty with fracture healing, stiffness, plate failure, and malunion. Infection following open metacarpal fractures is increased with wound contamination, delay in treatment greater than 24 hours, and systemic illness. However, the infection rate does not appear to be increased by the presence of internal fixation or other factors such as wound closure or wound size.

Keywords

thumb pain

thumb swelling

Bennett fracture

thumb carpometacarpal joint

surgical fixation

metacarpal fracture

closed reduction

open reduction

fracture complications

infection risk