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Duke Orthopaedics
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Wheeless' Textbook of Orthopaedics

Hand and Metacarpal Fractures


- See:
    - Metacarpal Neck Frx: (See 5th MCP Frx)
    - Unstable Metacarpal Shaft Frx

- Extra-articular Base Frx

- X-Rays:
    - isolated metacarpal views are not possible;
    - 30 deg pronated lateral: for index and long metacarpals;
    - 30 supinated lateral: for ring and little metacarpals;

- Non Operative Treatment:  
    - wrist is extended in 20 deg of extension, MP joint in 60-70 of flexion, & IP joints in extension;
    - metacarpal and phalangeal frx will typically unite prior to radiographic evidence, which may take upto 5 months;
    - metacarpal frx typically unite in 6 wks & phalangeal frx unite in 3 wks;
    - references:
             - Three cast techniques for the treatment of extra-articular metacarpal fractures. Comparison of short-term outcomes and final fracture alignments.

- Unstable Metacarpal Shaft Frx:
    - Spiral Fractures;
    - Oblique Fractures involving two metacarpals;
    - Transverse frxs;
    - K wires:
    - ORIF is indicated when:
             - displaced fracture involving the joint
             - soft tissue interposition preventing reduction
             - presence of multiple fractures;

- Surgical Approaches:
    - longitudinal extensile inicisions are used over dorsum of the hand;
    - border metacarpals are approached thru longitudinal incisions between 2nd and thrid or fourth and fifth metacarpals;
    - juncturae tendinum interconnecting the common extensor tendons can be split to enhance exposure (tag for later repair);

- Metacarpal Head Frx:
    - often badly comminuted;
    - consider a short period of splinting followed by early active motion;
    - this may mold the articular surface by using the soft tissue sleeve;
    - early motion will also prevent joint stiffness, but loos of motion is common after this type of fracture 

     



Unstable metacarpal and phalangeal fracture treatment with screws and plates.

Rotational deformity following metacarpal fracture.

Functional cast immobilization of thumb metacarpophalangeal joint injuries.

Carpometacarpal dislocations. Long-term follow-up.

Multiple carpometacarpal dislocations. A review of four cases.

A simplified technique to correct hyperextension deformity of the metacarpophalangeal joint of the thumb.

Treatment principles for proximal and middle phalangeal fractures.

External fixation of unstable metacarpal and phalangeal fractures.

External fixation of metacarpal and phalangeal fractures.

Management of malunited fractures of the metacarpal and phalangeal shafts

Unstable metacarpal and phalangeal fracture treatment with screws and plates.

Use of a minicondylar plate for metacarpal and phalangeal periarticular injuries.

Fixation of metacarpal and phalangeal fractures with miniature plates and screws.

Rigid fixation of phalangeal and metacarpal fractures.

Absorbable intramedullary implants for hand fractures. Animal experiments and clinical trial.

Manipulation and external fixation of metacarpal fractures.

Intra-articular metacarpal head fractures.

Metacarpal epiphyseal fractures.

Metacarpal fractures in the athlete.

Correction of rotary malunion of the fingers by metacarpal rotational osteotomy.

[Subcapital metacarpal fracture. Treatment and results within the scope of follow-up.]

Motion after metacarpophalangeal joint reconstruction in rheumatoid disease.

Year Book: Functional Treatment of Metacarpal Fractures: 100 Randomized Cases With or Without Fixation.

Surgical findings in clenched-fist injuries.

Carpometacarpal dislocations. Long-term follow-up.

Intraarticular osteotomy for malunion of metacarpal head fractures.

The management of delayed union and nonunion of the metacarpals and phalanges.

Salvage of the mutilated upper extremity with temporary ectopic implantation of the undamaged part.

Complications of plate fixation in the hand skeleton.

Problem Fractures of the Hand and *Wrist--Symposium:* Bone Healing in the Hand.

Tension wire fixation of avulsion fractures in the hand.

Treatment of hand injuries by external fixation.

Salvage of intraarticular malunions of the hand and wrist. The role of realignment osteotomy.

Rigid internal fixation in the hand: 104 cases.

Open hand fractures: an analysis of the recovery of active motion and of complications.

Low-velocity gunshot wounds of the metacarpal: treatment by early stable fixation and bone grafting.

Infections in open fractures of the hand.

Operative treatment of fractures and dislocations of the hand and wrist region in children.

Complications of smooth pin fixation of fractures and dislocations in the hand and wrist.

Metacarpal Fractures from the Orthopaedic Care Textbook



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, October 4, 2012 1:39 pm