Metacarpal Shaft Fracture S62.329A 815.03

ICD-9	Classification / Treatment / ORIF
Etiology / Natural History	Associated Injuries / Differential Diagnosis
Anatomy	Complications
Clinical Evaluation	Follow-up Care
Xray / Diagnositc Tests	Review References

synonyms: metacarpal fracture, metacarpal shaft fracture

Metacarpal Shaft Fracture ICD-10

Metacarpal Shaft Fracture ICD-9

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)(link is external)
7degree extensor lag develops for every 2mm of metacarpal shortening. (Strauch RJ, J Hand Surg 1998;23Am:519)(link is external)
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

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)(link is external) (link is external)or ORIF with mini-plates. (Bosscha K, Injury, 1993;24:166)(link is external)
Open fracture: consider mini-external fixation. (Freeeland AE, CORR, 1987;214:93)(link is external)

Metacarpal Shaft Fracture Associated Injury

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