History
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The patient with a metacarpal fracture or CMC dislocation presents with dorsal hand pain and swelling.
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Patients may report having limited motion in their fingers because of pain and/or deformity.
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Paresthesias are rare, unless they are associated with severe soft-tissue injury, as is seen with multiple metacarpal fractures or with high-energy crushing injuries.
Physical
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Physical examination in a patient with suspected metacarpal fracture and/or dislocation may reveal diffuse swelling and ecchymosis of the entire dorsal aspect of the hand, or findings may be limited over the involved bone.
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Tenderness and crepitus can be palpated at the fracture site.
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The prominence of the metacarpal head is decreased, with apex dorsal angulation of the fracture due to the pull of the intrinsic muscles.
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Look for a possible malrotation, which is easily missed on radiographs.
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The nails should be coplanar when the fingers are in extension, and all fingers should point toward the scaphoid tubercle in flexion.
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Finger crossover (scissoring) during flexion indicates a malrotation.
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As with any evaluation of the upper extremity, the neurovascular status should be documented.
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The skin should be evaluated for lacerations or puncture wounds, which suggest an open fracture.
Related Medscape topics:
Resource Center Vascular Surgery
Specialty Site Neurology & Neurosurgery
Causes
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A sudden, forceful axial load or direct trauma can lead to transverse fractures of the metacarpal neck or shaft, as well as CMC fracture-dislocations.
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Torsional forces may produce spiral or oblique fractures of shaft. These injuries are most likely to be associated with a rotational deformity. [6]
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A clenched-fist injury is commonly associated with metacarpal neck fractures ("boxer fractures"). [7] The usual mechanism is punching a wall or an assailant (often in the mouth).
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High-energy crush injuries (which are rarely seen in sporting activities) lead to associated soft-tissue damage and often involve multiple metacarpal fractures.
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Displaced fourth and fifth metacarpal fractures, anteroposterior view.
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Displaced fourth and fifth metacarpal fractures, lateral view.
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Fourth and fifth metacarpal fractures, oblique view.
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Fourth and fifth metacarpal fractures after intramedullary pinning, anteroposterior view.
