At some centres this may be an orthopaedic team this guideline will refer to ‘hand surgery’ to encompass both specialty fields.Symptoms will depend on which type of fracture you have. Information Specific to Royal Children’s Hospital: Any metacarpal fractures requiring specialist input are handled by the Plastic Surgery team. et al “Pediatric Hand Fractures” Hand Clin 2013 29(4): 569-78 “Fractures in the Child’s Hand” Current Orthopaedics 2006 20:461-66 “Fight bites” that are not recognised or addressed early can result in septic arthritis or infections of the deep spaces of the hand.Īrthritis may complicate any intra-articular fracture of the metacarpal base or head.Ĭornwall, “Paediatric Finger Fractures: Which Ones Turn Ugly” J. Unrecognised/uncorrected rotational deformity can result in significant functional hand impairment What are the potential complications involved with this injury? What advice should I give to parents?Įlevation of the limb, typically in a sling.Īvoid activities involving the possibility of heavy impacts on the hand or cast, such as sports.ġ2. If the referral is delayed, please contact the hand surgery clinic.ġ1. Discuss with the on-call registrar to ensure this appointment is appropriately timed. The hand is then splinted in the safe hand position as above.įollow up should be arranged in hand surgery clinic in approximately one week – at RCH, this is the Plastics Dressings clinic . After applying some longitudinal traction to the digit, the MCP is flexed to 90 degrees and then axial loading applied to the proximal phalanx to correct any flexion angulation. Where required, reduction can take place under procedural sedation and/or regional anaesthesia. What is the usual ED management of this fracture?Ĭlosed metacarpal injuries not needing reduction should be splinted in the safe hand position (Wrist in 20 degrees of extension, MCP joints in 70 degrees of flexion, IP joints in full extension) Other injuries can be followed up in Hand Surgery clinic within the next 7 days.ĩ. Urgent exploration and washout is required) Open fractures (including fight bites as illustrated above - any laceration over the metacarpal heads should be treated as highly suspicious for these injuries.įractures at the head or base of the metacarpal should not be manipulated in the ED.Ĩ. the 5th metacarpal neck “Boxer’s Fracture”), greater degrees of apex-dorsal angulation may be accepted, so long as the clinical examination doesn’t reveal findings of malrotation, extensor lag (‘pseudoclawing’), or ‘MC head in the palm’ (palpable MC head because of angulation, felt palmarly). For Little Metacarpal: >20 degrees of angulation, or any significant rotational deformityįor metacarpal neck fractures (i.e.For Ring metacarpal: >15 degrees of angulation, or any rotational deformity.For Index and Middle metacarpals: >10 degrees of angulation, or any rotational deformity.When is reduction (non-operative and operative) required?Īs a loose guide for shaft fractures (there are many other factors at play here): To better appreciate any dorsal subluxation in these injuries, a lateral or oblique view should be examinedįor Fractures of the Thumb metacarpal see thumb fracture CPG 7. Left: neck fracture little finger metacarpal (sometimes labelled a “Boxer’s Fracture” when found in little finger metacarpal) What radiological investigations should be ordered?ĪP, lateral and oblique films of the hand This occurs when a tooth penetrates the MCP joint Risk of deep infection here is very high, regardless of whether abnormality is present on the xray: surgical admission for exploration and washout is indicated.ĥ. This is demonstrated in the image below., with the normal exam at left, and rotational deformity of the ring finger shown at right.Īn open wound over the dorsal aspect of the metacarpal head may suggest a “fight bite”. Looking for ‘scissoring’ or overlap of the fingertips. There may be rotational deformity, which is best identified by having the patient flex her fingers into a loose grip. There is usually significant bruising and tenderness in the part of the hand corresponding to the fracture site. They usually occur due to a blunt force applied to a clenched fist such as punching a fixed object or from falling onto a closed fist. Metacarpal fractures are a common injury in older children and adolescents, particularly the little and ring fingers. How common are they and how do they occur? These are classified as closed or open, by which digit is injured, by anatomical site of fracture (base, shaft or neck), and by displacement/angulationģ. Note that fractures of the thumb metacarpal require special consideration: see thumb fracture guideline 2.
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