Case 60 Metacarpal and Phalangeal Fractures

W. Kelsey Snapp and Reena A. Bhatt

Case 60 Metacarpal and Phalangeal Fractures

Case 60 (a-c) A 23-year-old male presents to the emergency department after striking a wall. X-rays of the hand are shown. The patient complains of pain over the ulnar side of the hand and deformity of the hand.

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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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 60 Metacarpal and Phalangeal Fractures
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