Metacarpal Fracture and Dislocation Workup

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

Imaging Studies

Radiography

Standard views for all hand injuries are those obtained in the posteroanterior (PA), lateral, and oblique planes.

Acquisition of images in the Brewerton view may be indicated to evaluate the patient for CMC dislocations or for suspected avulsion of the collateral ligament. [8] To obtain Brewerton images, anteroposterior (AP) imaging is performed with the MCPJ flexed 65°, with the tube angled 15° from the radial aspect to the ulnar aspect.

The Bora view, a special oblique view of the hand, is useful for assessing suspected fracture-dislocations of the fourth or fifth CMC joint, which are difficult to delineate on standard PA radiographs. This view is obtained with AP imaging of the hand with the forearm pronated 30° from full supination. With CMC injuries, a standard oblique view should also be included in a trauma imaging series of the hand.

Computed tomography (CT) scanning

CT scanning may be indicated for investigating intra-articular fractures of the metacarpal head or the metacarpal at the base of thumb in association with multiple fragments (Rolando fracture).

CT scans may also aid in evaluating CMC fracture-dislocations, injuries to the central digits, and injury to the fifth digit (reverse Bennett fracture).

With subtle injuries of the CMC joints, CT scanning may be required to aid the clinician in determining the diagnosis and in making management decisions.