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synonyms: metacarpal fracture
Metacarpal Base Fracture ICD-9
Metacarpal Base Fracture ICD-9
- 815.02 Fracture of metacarpal bone; closed, base of other metacarpal bone
- 815.12 Fracture of metacarpal bone; open, base of other metacarpal bone
Metacarpal Base Fracture Etiology / Epidemiology / Natural History
Metacarpal Base Fracture Anatomy
- metacarpals are concave on the palmar surface, thus plates should be pre-bent to avoid volar gaping at the fracture site.
- 2nd and 3rd metacarpals articulate with the trapezoid and capitate. Limited motion exists in 2nd, 3rd CMC joints.
- 4th and 5th metacarpals articulate with the hamate and have greater
- intermetacarpal ligament prevent more than 3-4mm of shortening. (Eglseder WA, JOT 1997:11:441)
- 7degree extensor lag develops for every 2mm of metacarpal shortening. (Strauch RJ, J Hand Surg 1998;23Am:519)
Metacarpal Base Fracture Clinical Evaluation
- evaluate cascade, any scissoring or overlap indicates need for reduction +/- fixation
Metacarpal Base Fracture Xray / Diagnostic Tests
- P/A and lateral views of hand
- 30-45 degree suppinated or pronated views
- metacarpal base fractures are easily missed due to poor xrays.
Metacarpal Base Fracture Classification / Treatment
- Undisplaced: buddy-taping
- Displaced Extra-articular:(angulation >30 degrees, shortening >4mm, any rotational deformity) =CRPP vs ORIF. Long oblique fractures may be treated with parallel miniture screw fixation (Freeland, Orthopaedics 17:199;1994). Tranverse fractures may be treated with intrameduallary nails (Gonzalez MH, CORR 1996;327:47) or ORIF with mini-plates. (Bosscha K, Injury, 1993;24:166). Open fracture: consider mini-external fixation. (Freeeland AE, CORR, 1987;214:93)
- Displaced Articular: CRPP vs ORIF with k-wires or mini-lag screws.
Metacarpal Base Fracture Associated Injuries / Differential Diagnosis
- fracture of adjacent metacarpal
- fight bite
Metacarpal Base Fracture Complications
- Malunion
- Nonunion
- stiffness
- hardware failure
- complex regional pain syndrome
- infection
Metacarpal Base Fracture Follow-up Care
Metacarpal Base Fracture Review References
- Freeland AE, Geissler WB, Weiss AP, Operative Treatment of Common Displaced and Unstable Fractures of the Hand, JBJS 2001;83A:928-945
- Freeland AE, Orbay JL. ORIF of the Tubular Bones of the Hand In: Stickland JW, Grahma TJ, editor. Hand 2nd ed. Master Techniques in orthopedic surgery. Philadeplhia: Lippincott-Raven; 2004. p 3
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