Metacarpal #

• Fractures of metacarpal head, neck or shaft. (1,2)
  • Head fractures are generally rare
  • Neck is the most common MCP fracture site (3)
  • Most fracture patterns tend to be stable and can usually be managed conservatively.
• Mechanism of injury (1,2)
  • Neck fractures commonly sustained after punching a hard object (axial load to a fist)
  • Shaft fractures tend to be oblique

Specific to MCP# (1,2):

• Neck MCP fractures usually present with apex dorsal angulation
  • Depressed knuckle with the head protruding into the palm
• Assess and document extensor lag, scissoring and rotation clinically
• Imaging: AP, LAT, OBL
  • Assess angulation of the metacarpal head on XR

• This section developed with the help of BSSH Hand Trauma App (4)
• Remove jewellery
• Provide pain relief

• Manipulation required if:
  • Dislocation
  • Significant deformity, especially where lag or scissoring evident
  • Neurovascular compromise (Discuss with senior first!)

• Surgical Treatment and admission required urgently if:
  • Open fracture
  • Neurovascular compromise

If closed and neurovascularly intact:

• LA block/Entanox and MUA if required
• Buddy tape finger to neighbor distally and apply POP volar slab in position of safe immobilisation (Edinburgh position)
• Provide a high arm sling
• Senior review. Referral to see the patient at the next available clinic.

If attempting manipulation of the fracture make sure to re-XR (AP, oblique and lateral) after manipulation and immobilization.

If no MUA and immobilization only repeat XR also required

If open:

• Thorough washout of the wound
• Dress wound
• Immobilize fracture with POP
• Start IV antibiotics (consult local antimicrobial guidelines)
• Tetanus prophylaxis
• Discuss with senior
• Admit patient

If neurovascularly compromised may need to go to theatre urgently. DISCUSS WITH SENIOR. Keep patient NBM.