Metacarpal Fracture and Dislocation Clinical Presentation

Updated: Sep 07, 2018
  • Author: David R Steinberg, MD; Chief Editor: Craig C Young, MD  more...
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Presentation

History

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  • The patient with a metacarpal fracture or CMC dislocation presents with dorsal hand pain and swelling.

  • Patients may report having limited motion in their fingers because of pain and/or deformity.

  • 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.

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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.

  • Tenderness and crepitus can be palpated at the fracture site.

  • The prominence of the metacarpal head is decreased, with apex dorsal angulation of the fracture due to the pull of the intrinsic muscles.

  • Look for a possible malrotation, which is easily missed on radiographs.

  • The nails should be coplanar when the fingers are in extension, and all fingers should point toward the scaphoid tubercle in flexion.

  • Finger crossover (scissoring) during flexion indicates a malrotation.

  • As with any evaluation of the upper extremity, the neurovascular status should be documented.

  • 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

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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.

  • Torsional forces may produce spiral or oblique fractures of shaft. These injuries are most likely to be associated with a rotational deformity. [6]

  • 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).

  • 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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