Comminuted fracture hand11/16/2023 Your doctor will likely put your broken bone back into place often, this can be done without surgery.Resultantly, fractures of the fourth and fifth metacarpal neck may also be referred colloquially to as scrapper, bar-room, or street-fighter's fractures ref.For fractures that are displaced, or not lined up correctly: It should be noted that only a poorly thrown punch results in this type of fracture, and such injuries are actually uncommon in professional boxers who are taught to transfer as much power as possible through the second and third metacarpals 2,5. History and etymologyīoxer fractures are named after the common mechanism of injury, namely that of throwing a punch. Prolonged immobilization can lead to stiffness.įractures of the fourth metacarpal neck can be treated in a similar fashion, whereas the second and third metacarpals usually require internal fixation 5. No rotational deformity is acceptable as this can lead to significant disability, with the little finger overlapping other digits during flexion 4. Articular step-off in cases with intra-articular extension should be no more than 1-2 mm 4.Ī short arm gutter-splint is applied, with flexion of the metacarpophalangeal joint, typically for 2-3 weeks followed by buddy-strapping 4,5. If angulation exceeds this, palmar pain and reduction of strength may be present on gripping 3. When the fracture is of the shaft, less deformity is acceptable (less than 20 degrees). The apex dorsal angulation for neck fractures should not exceed 30-40 degrees 3,4. An ulnar nerve block may help 5.Ī degree of residual palmar angulation is acceptable. Presence of rotation: this is critical! (see below)Īssess for any associated fractures and/or dislocationsĪlthough it can be treated conservatively, it is relatively unstable, and K-wire fixation is often required for better cosmetic results.Ĭlosed reduction can be achieved by stabilizing the proximal part of the metacarpal dorsally and applying pressure to the head of the metacarpal from the palmar aspect while flexing the proximal phalanx 3. Involvement of the articular surface of the MCP joint Location, especially distance along the shaft In addition to stating that a fifth metacarpal fracture is present, a number of features should be evaluated and commented up: Lines may also be drawn along the dorsal cortex to assess palmar angulation 7. When this is not possible the oblique view can be used, however, this results in less accurate measurements that tend to overestimate the degree of angulation 6. The degree of palmar angulation is best assessed on the lateral radiograph, with lines drawn through the medullary canal. Soft tissue gas which should be treated as suspicious for an open injury Intra-articular extension, and degree of articular step-offĭegree of rotation: angulation on AP film implies a degree of rotation Morphology of the fracture: transverse, spiral, comminuted, oblique, etc. Spiral fractures, which are less common, can be harder to visualize 2.įeatures which should be commented upon include: Typically the fracture appears in the transverse plane through the metacarpal neck, with volar angulation of the distal fragment. Plain radiographs are in almost all cases the only imaging required. Spiral fractures or angulation in other directions are also sometimes encountered. In most cases, the neck fracture is typically transversely-oriented and minimally impacted with volar angulation. Typical solid surfaces are walls or human faces, with young adult males by far the most commonly affected group (~95%) 1. Boxer fractures are an impaction injury that almost always is a consequence of a direct blow with a clenched fist against a solid surface which causes axial loading of the 5 th metacarpal.
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