Metatarsal & Metacarpal Fractures

Author: Michelle Lin, MD
Updated: 12/13/2013

Metatarsal and Metacarpal Fractures

Metacarpal and metatarsal drawing

Metatarsal Head

  • Typically operative, unless MCP stable and < 20% articular surface involvement

Metatarsal Neck

  • Most are nonoperative
Urgent closed reduction needed if:
  • > 10°, 20°, 30°, 40° angulation for 2nd-5th MCs, respectively, OR
  • ANY rotational deformity (note scissoring with composite flexion)

Metacarpal Shaft

Most are nonoperative, especially 3rd and 4th MC because of inter-MC ligaments

Urgent closed reduction needed if
  • > 10°, 10°, 20°, 20° angulation for 2nd-5th MCs, respectively, OR
  • ≥ 5 mm shortening, OR
  • ANY rotational deformity
PEARL
  • Short oblique fractures (length of fx < 2x bone diameter) and displaced transverse fractures typically unstable and may need fixation.
  • Splint with dorsal pressure over the dorsally angulated fracture site.

Metacarpal Base

1st MC (thumb)
Intraarticular:
  • Bennett (fx fragment on ulnar side of 1st MC)
  • Rolando (fx fragment on ulnar & radial side of 1st MC): Typically unstable and require operative repair
Extraarticular:
  • Allow up to 30° of apex-dorsal angulation and 4 mm shortening before operative repair
2-4th MC
Operative repair if ≥ 2 mm articular surface displacement or significant angulation
5th MC
Extraarticular: Typically stable because of inter-MC ligaments
Intraarticular (high-energy injury): Unstable
  • Fracture line between inter-MC ligaments and insertion of extensor carpi ulnaris tendon, causing base to displace proximal and dorsal
  • Typically will need fixation
PEARL: 4th and 5th MC base fractures are frequently fx-dislocations. Check lateral xray to ensure the carpo-MC joint is reduced.

Splinting

Digit Splint Position
Thumb Thumb splica Wrist extension 20°, thumb Abduction
Index, middle finger Radial gutter or volar Wrist extension in 20°, MCP flexion in 90°, keep IPs free
Ring, small finger Ulnar gutter Wrist extension in 20°, MCP flexion in 90°, keep IPs free

References

  • Wheeless Online. Available at: http://www.wheelessonline.com/ortho/hand_and_metacarpal_fractures. Accessed August 1, 2017.
  • Browner BD. Skeletal Trauma, Basic Science, Management, and Reconstruction. Elsevier Health Sciences; 2009.
  • Hockberger RS, Walls RM. Rosen's Emergency Medicine - Concepts and Clinical Practice, 2-Volume Set,Expert Consult Premium Edition - Enhanced Online Features and Print,7, Rosen's Emergency Medicine - Concepts and Clinical Practice, 2-Volume Set. Elsevier Health Sciences; 2009.
  • Emedicine. Available at: http://emedicine.medscape.com/article/1239721-overview. Accessed August 1, 2017