Sean Coulson D.O.
HPI: Pt is a 24 y/o male who presents for fall, complaining of right lateral anterior palm pain. No medical hx, TDap up to date, no anticoagulation.
Physical Exam: Tender to palpation over the medial right palm on the anterior aspect. Radial pulse 2+, Cap refill intact, Strength and sensation intact, no abrasions / lacerations / skin changes. When the patient closes the right hand and makes a fist, the right 2nd finger angulates and bends overtop the 3rd phalanx (as seen below).
Pertinent Information About 2nd-5th Metacarpal Fractures:
Is it an open vs closed? Does it involve the intra articular space? Cascade of finger placement, malrotation / scissoring (see photo below)?
What are acceptable degrees of angulation based on the digit?
1st metacarpal: < 10 degrees
2nd: <20 degrees
3rd: < 30 degrees
4th: < 40 degrees
If less than the stated degree, may consider reduction, splint and discharge with orthopedic follow up if no other concerning features are present.
Other Indications for operative management and in ED orthopedic consult
Angulation greater than what’s stated above
Shortening > 5mm
Intraarticular or open fracture
Abnormal finger cascade regardless of degree of angulation
Multiple metacarpal fx
Management
+/- Ortho evaluations w/ operative fixation as described above
4th / 5th MCP fx: ulnar gutter splint
2nd / 3rd MCP fx: radial gutter splint
References:
https://www.ncbi.nlm.nih.gov/books/NBK551532
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355092
https://www.journal-cot.com/article/S0976-5662(20)30230-7/fulltext
