Metacarpal Shaft Fracture S62.329A 815.03

Metacarpal shaft fracture xray

Metacarpal shaft fracture ORIF xray

synonyms: metacarpal fracture, metacarpal shaft fracture

Metacarpal Shaft Fracture ICD-10

Metacarpal Shaft Fracture ICD-9

  • 815.03(closed)
  • 815.13(open)

Metacarpal Shaft Fracture Etiology / Epidemiology / Natural History

  •  Angulation >30 degrees or shortening >4mm can lead to grip weakness, loss of endurance, cramping and clawing.
  • Any rotational deformity can lead to digital overlap during finger flexion

Metacarpal Shaft 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)
  • See Hand Anatomy.

Metacarpal Shaft Fracture Clinical Evaluation

  • Generally have obvious pain and deformity at the fracture site.
  • Document neurovascular status of the finger before and after any reduction.
  • Evaluate cascade, any scissoring or overlap indicates need for reduction +/- fixation

Metacarpal Shaft Fracture Xray

  • P/A and lateral views of hand
  • 30-45 degree suppinated or pronated views

Metacarpal Shaft Fracture Classification / Treatment

  • Non-displaced
    -buddy taping (CPT=26600 closed treatment MC fracture without manipulation, each bone: 26605=with manipulation)
  • Displaced (angulation >30 degrees, shortening >4mm, any rotational deformity) (every 2 mm of metacarpal shortening results in 7 degrees of extensor lag. (Strauch RJ, J Hand Surg Am. 1998 May;23(3):519-23).
    -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)

Metacarpal Shaft Fracture Associated Injury

  • Fight bite

Metacarpal Shaft Fracture ORIF Complications

Metacarpal Shaft Fracture Follow-up

  • Post-op: Splint in "safe" position (wrist extended 15-20 degrees, MCP joints flexed 70 degrees, PIP joint in 0-10 degrees flexion)
  • 7-10 Days: remove splint. Place in removable splint with fingers buddy-taped. Encourage gentle ROM
  • 6 Weeks: Check xrays. Progress with ROM exercises. Activity modifications: no heavy manual labor, no contact sports, no lifting >5 lbs.
  • 3 Months: Check xrays. If union is complete return to full activities. Assess motion, consider occupational therapy if indicated.
  • 6 Months: Assess motion,
  • 1Yr: F/u xrays, assess outcome.

Metacarpal Shaft Fracture Review References

  • Rockwood and Greens
  • Greens Hand Surgery
  • Freeland AE, Geissler WB, Weiss AP, Operative Treatment of Common Displaced and Unstable Fractures of the Hand, JBJS 2001;83A:928-945
  • Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg. 2008 Oct;16(10):586-95
  • 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