The majority of metacarpal fractures can be treated conservatively. Treatment options: fracture fixation with K-wires, interfragmentary screws, or mini plates.Deformities leading to functional impairment: severe angulation, shortening, or malrotation.Displaced fractures with a step-off of > 1 mm or subluxation/ dislocation of the CMC joint.At the time of injury the volar cortex fractures, resulting in an apex-dorsal angu-lation fracture pattern with flexion of the meta-carpal head. Intraarticular fractures occupying > 25% of the articular surface Metacarpal Neck Fractures Metacarpal neck fractures are most commonly seen in the small finger and are often referred to as boxer’s fractures, given their prevalence in the amateur pugilist. 5 th metacarpal fractures : ulnar gutter splint/cast or twin taping to the ring finger.2 nd–4 th metacarpal fractures: palmar wrist splint/cast.Whether operative treatment is superior to nonoperative treatment for oblique and/or spiral finger metacarpal shaft fractures (MSFs) is unknown. 1 st metacarpal fractures: short-arm thumb spica splint Background: Finger metacarpal fractures represent up to 31 of all hand fractures, and most can be treated nonoperatively.4 weeks, depending on physical examination findings Mild deformity is often preferable to surgical treatment.Simple, closed, and stable metacarpal fractures.Ensure concomitant injuries and/or infections are also treated.See “ General fracture care” in “ General principles of fractures.”.Type IV metacarpal base fracture: a pediatric physeal fracture, most commonly a type II Salter-Harris fracture (see “ Pediatric fractures”).Type III metacarpal base fracture: transverse or oblique fracture of the metacarpal base Figure 1 The fifth metacarpal Figure 2 A sign of a boxers fracture, with the small finger crossing over another finger Figure 3 An example of a cast worn after a boxers fracture Causes The most common cause of a boxer’s fracture is the force applied to the fifth metacarpal bone when the fist punches something while in a clenched position.The fragments often form a T- or Y-shaped pattern.Comminuted fracture of the metacarpal base.Type II metacarpal base fracture ( Rolando fracture).The 1 st metacarpal shaft fragment is radially and proximally dislocated by the pull of the abductor pollicis longus muscle.Two-part fracture of the metacarpal base.Type I metacarpal base fracture ( Bennett fracture-dislocation).Type of fracture: transverse, oblique, spiral, comminuted (see “ Fracture classification” in “ General principles of fractures”).Intra-articular fractures at the base of the fifth metacarpal. Conservative treatment of boxers fracture: a retrospective analysis. Osteosynthesis using perpendicular pins in the treatment of fractures and malunions of the neck of the 5th metacarpal bone. A fracture of the 4 th or 5 th metacarpal neck is called a boxer's fracture because it is usually caused by a closed fist forcibly coming into contact with a solid surface. Fractures of the metacarpal neck of the little finger.Fractures of the metacarpal head, neck, base, and shaft.
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