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

Only gold members can continue reading. Log In or Register to continue

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