Case 60 Metacarpal and Phalangeal Fractures
60.1 Description
Transverse fractures of the ring and small finger metacarpal shafts with angulation, rotation, and shortening of the affected digits
Dorsal prominence of the hand secondary to dorsally angulated fractures
60.2 Work-Up
60.2.1 History
Mechanism of injury (e.g., assault, fall, motor vehicle collision, “fight bite,” or gunshot)
Time since injury
Any additional or associated injuries
Prior history of similar injury and hand surgery
Hand dominance
Occupation
Smoking history
Comorbidities
60.2.2 Physical Examination
Evaluate for open wound and additional injuries
If open, determine degree of contamination from wound
Examine resting cascade of the hand while in slight flexion
The distal phalanges should all point toward the scaphoid tubercle
Assess for angulation, scissoring, or malrotation of the digits
Evaluate for shortening of the digits relative to the contralateral hand
Assess perfusion and sensibility of the affected digits
Viability and adequacy of soft tissue coverage
60.2.3 Pertinent Imaging or Diagnostic Studies
Standard three-view X-rays (anteroposterior, lateral, and oblique) of the hand should be obtained to assess the fracture or presence of foreign bodies
Consider computed tomography (CT) scan in cases of severe comminution/suspected articular disruption
60.3 Patient Counseling
Patient should be counseled on critical importance of compliance with splinting/casting, surgery if indicated, and hand therapy
Smoking cessation should be included in preoperative counseling
Potential complications should be reviewed including but not limited to stiffness, infection, pain, nonunion, and malunion
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