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PV card: Metacarpal fractures

Posted Dec 13 2012 12:00am

What do these two patients with metacarpal fractures have in common?

Answer: These patients have injuries which need reduction in the ED.
  • Patient #1: Rotation deformities of the fingers, while held in flexion should be reduced. All fingers should normally point towards the patient's scaphoid bone.
  • Patient #2: Fractures of the base of the 4th and 5th MCs often are associated with carpometacarpal (CMC) dislocations. This 4th MC fracture-CMC dislocation should definitely be reduced.  
Metacarpal (MC) fractures are common injuries, which often spark discussions about whether they should be reduced in the ED urgently.
  • What are the criteria for acceptable degrees of angulation? Are these criteria different for the MC neck versus shaft? 
  • Which fractures tend to be unstable and thus require eventual operative repair? 
  • How should I splint the injury?

Here's a quick-reference card to help guide your management decisions. These recommendations may vary slightly based on what references you use. You may need to tailor your decisions based on your regional practices.

Feel free to download this card and print on a 4'' x 6'' index card. [ MS Word ] [ PDF ] See  other Paucis Verbis cards .

Thanks to Dr. Nicole Strauss at the UCSF-SFGH Orthopaedic Trauma Institute and my go-to hand expert for her input.

Additional reference
Friedrich JB, Vedder NB. An evidence-based approach to metacarpal fractures. Plast Reconstr Surg. 2010 Dec;126(6):2205-9.
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