Eshealthtips.com – A Metacarpal Neck Fracture can result in significant pain, disability, and loss of motion. This is a common injury and can be treated effectively with conservative treatments such as surgery and physical therapy. Patients with this fracture may also benefit from a K-wire fixation or reduction. This procedure involves pushing the fracture fragments back into position. The video below shows a procedure called a 90-90 approach. This involves flexion of the PIP and MCP to 90 degrees. This forces the distal fragment to move. The PIP joint is flexed to a similar angle. This stretch helps the collateral ligaments in the MCP joint.
Locking Plate Is Effective Treatment
In some cases, a K-wire or locking plate may be the preferred treatment. This depends on the nature of the injury. For instance, compression on the fracture may result in angulation or rotational malalignment. If the underlying cause of the injury is not apparent, active motion should not begin until at least four weeks post-injury. The locking plate has the highest rate of success, according to a review by Zong, S. L. et al.
X-rays are the most common form of diagnosis for metacarpal neck fractures. The radiologist will measure the angulation (angle of rotation) of the mangled bone. It will look like a “C” or “X-ray” fracture. There is no definitive cure, but many treatments are available, and the best course of treatment is to consult your physician and get a diagnosis.
If your doctor finds a metacarpal neck fracture to be dislocated, open reduction may be indicated. Anterior and lateral x-rays are also helpful. Depending on which structures are involved in the injury, open reduction or a closed reduction may be the best option. If the fracture is not properly recognized, it could lead to long-term grip weakness and functional deficits related to a malrotated digit.
Confirming the Diagnosis with Conservative Medicine
An X-ray of the fifth metacarpal neck is necessary to confirm a diagnosis. It must be asymmetric to indicate the fracture. The angulation must be more than 45 degrees for it to be classified as a fifth metacarpal neck fracture. A patient with a cleft hand may need a surgical repair. If there is a lack of angulation, conservative treatment is an alternative.
In a patient with a metacarpal neck fracture, lateral x-rays are helpful in diagnosis. In the 5th metacarpal, apical-dorsal angulation of the fracture is acceptable. If the angulation is not asymmetric, acromasal x-rays may be used to aid in the correct orientation of the bones.
Generally, a metacarpal neck fracture is a fracture of one of the five metacarpal bones in the hand. Each of the metacarpal bones includes a base, a shaft, and a head. The distal head of the metacarpals articulates with the proximal phalanges to form knuckles. The 1st and third of the metacarpals are the thickest and the 3rd is distinguishable by a styloid process. A typical metacarpal neck fracture occurs during contact sports and athletic events.
How to Stabilize the Wrist
The primary care doctor will perform a closed reduction if the angulation and rotational malalignment are too severe. A metacarpal neck fracture that is too angular may require surgical management. The angulation of the metacarpals is measured using an angular-compressive device. The angled x-rays will not show a fractured finger. The surgeon will use a fusion or a plate and screw to stabilize the wrist.
Anatomical treatment should be performed to stabilize the fractured finger. A closed reduction is an alternative to a plate and screws. There are no known risks associated with this procedure. A single fracture is usually not asymptomatic, but a closed reduction can lead to grip weakness. Surgical treatment will depend on the severity of the injuries. If anatomical alignment is normal, then the patient can resume light resistance exercises.
The patient’s symptoms should be diagnosed and treated promptly. The fracture should be monitored closely to avoid further complications. If the fracture is too small, a locking plate should be applied. If there is no angulation, a lock plate should be used. In addition to a locking plate, a patient should undergo a full range of active motion. If a lock plate is used, a surgeon should not reposition the fractured bone.
Poolman, Rudolf W., et al. “Conservative treatment for closed fifth (small finger) metacarpal neck fractures.” Cochrane Database of Systematic Reviews 3 (2005).
Strub, B., et al. “Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study.” Journal of Hand Surgery (European Volume) 35.9 (2010): 725-729.