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The Journal of Hand Surgery, European... Sep 2023Metacarpal fractures are common and can be functionally disabling. The majority are managed non-operatively. When surgical intervention is indicated, various methods of... (Review)
Review
Metacarpal fractures are common and can be functionally disabling. The majority are managed non-operatively. When surgical intervention is indicated, various methods of fixation are available with the utility of each being based on injury pattern, patient function and surgeon preference. Early mobilization, especially in case of open reduction and internal fixation, is a critical component of treatment to prevent stiffness and restore function. When possible, a fixation construct that can withstand the applied forces of early postoperative motion is chosen. We provide an updated description for diagnosis, treatment options and operative fixation for metacarpal fractures.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Hand Injuries; Fracture Fixation, Internal; Open Fracture Reduction
PubMed: 37704027
DOI: 10.1177/17531934231184119 -
Instructional Course Lectures Feb 2017Metacarpal fractures account for 10% to 35% of all pediatric hand fractures. Pediatric metacarpal fractures commonly occur in patients aged 13 to 16 years, with most...
Metacarpal fractures account for 10% to 35% of all pediatric hand fractures. Pediatric metacarpal fractures commonly occur in patients aged 13 to 16 years, with most injuries sustained during sports activities. Pseudoepiphyses can be confused with metacarpal fractures; however, a careful physical examination can help physicians distinguish the two. Thumb metacarpal base fractures that involve the physis warrant special attention. Thumb metacarpal base fractures with lateral metaphyseal fragments and pediatric Bennett fracture variants (Salter-Harris type III and type IV fractures) are unstable and require surgical management. Finger metacarpal base fractures, especially those in young children, are often the result of high-energ y injuries and should increase a physician's concern for compartment syndrome. Metacarpal shaft fractures can result from a simple bending moment; however, they also can result from a rotational force, which may cause finger crossover that will not remodel and requires reduction. Metacarpal neck fractures account for three-fourths of all finger metacarpal fractures, and increasing acceptable alignment of the index finger through the little finger metacarpal necks (10°, 20°, 30°, and 40° across the digits, respectively) is commonly recommended. Metacarpal head fractures are rare intra-articular injuries that require anatomic fixation and may be underappreciated in children because of the complex geometry and largely cartilaginous nature of the metacarpal head.
Topics: Adolescent; Child; Finger Injuries; Fractures, Bone; Hand Injuries; Humans; Metacarpal Bones; Thumb
PubMed: 28594520
DOI: No ID Found -
Clinics in Plastic Surgery Jul 2019The management of phalangeal and metacarpal fractures continues to evolve. Nonoperative or less invasive techniques, limiting the need for soft tissue dissection and... (Review)
Review
The management of phalangeal and metacarpal fractures continues to evolve. Nonoperative or less invasive techniques, limiting the need for soft tissue dissection and resultant stiffness, are being developed and becoming more popular. The competing forces of fracture stability to optimize healing and early mobilization to optimize function need careful balancing. As imaging, equipment, and techniques improve, hand surgeons can tailor individualized care to the unique needs of each patient.
Topics: Finger Phalanges; Fracture Fixation; Fractures, Bone; Hand Injuries; Humans; Metacarpal Bones
PubMed: 31103086
DOI: 10.1016/j.cps.2019.02.011 -
Hand Clinics Feb 2024The majority of phalangeal and metacarpal fractures will proceed to union when appropriately treated. However, when a nonunion does occur, it can lead to significant... (Review)
Review
The majority of phalangeal and metacarpal fractures will proceed to union when appropriately treated. However, when a nonunion does occur, it can lead to significant functional impairment for patients and societal costs. Operative intervention is typically required in these cases, but the technique can vary depending on each individual patient scenario. This article provides an overview of nonunions of the metacarpals and phalanges in the hand, including incidence, risk factors, current treatment options, and postoperative care.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Fracture Fixation, Internal; Hand Injuries; Finger Phalanges
PubMed: 37979984
DOI: 10.1016/j.hcl.2023.09.003 -
Clinics in Sports Medicine Jan 2015Metacarpal and phalangeal fractures are common skeletal injuries, accounting for 10% of all fractures. Approximately one-quarter of these injuries occur during athletic... (Review)
Review
Metacarpal and phalangeal fractures are common skeletal injuries, accounting for 10% of all fractures. Approximately one-quarter of these injuries occur during athletic events. Although an acceptable and stable reduction remains a key principle in this patient group, early mobilization and return to play may be higher priorities than in other patient populations. Orthopedic implant designs and techniques are evolving to facilitate operative fracture stabilization, improve union rates, and accelerate the postoperative course with early range of motion and return to play. This article discusses common patterns of metacarpal and phalangeal fractures resulting from athletic injuries, and current treatment strategies.
Topics: Athletic Injuries; Finger Phalanges; Fracture Fixation; Fractures, Bone; Humans; Metacarpal Bones; Radiography; Range of Motion, Articular; Recovery of Function
PubMed: 25455397
DOI: 10.1016/j.csm.2014.09.009 -
Plastic and Reconstructive Surgery Jul 2017After reading this article, the participant should be able to: 1. Understand metacarpal anatomy and its role in fracture pathology. 2. Determine when surgical... (Review)
Review
LEARNING OBJECTIVES
After reading this article, the participant should be able to: 1. Understand metacarpal anatomy and its role in fracture pathology. 2. Determine when surgical intervention is needed for metacarpal fractures. 3. Understand the various treatment options for surgical fixation of metacarpal fractures. 4. Describe the role for external fixation in managing difficult metacarpal fractures.
BACKGROUND
Metacarpal fractures are common injuries that plastic surgeons should be able to evaluate and treat. The goal of this review is to highlight current evidence for managing metacarpal fractures. This Continuing Medical Education article consists of a literature review, illustrations, videos, and an online Continuing Medical Education examination.
METHODS
The authors reviewed the scientific literature from 2000 to 2015 regarding treatment of metacarpal fractures. Cadaver models were used for instructional videography demonstrating common surgical techniques. Multiple-choice questions were created to review pertinent topics. A discussion and references are provided.
RESULTS
Numerous treatment options have been described for metacarpal fractures, including splinting, percutaneous fixation, open reduction with internal fixation, and external fixation. All modalities are acceptable strategies for treating metacarpal fractures. The ultimate goal is to maximize hand function with minimal morbidity.
CONCLUSIONS
A thorough understanding of treatment modalities is helpful in evaluating and managing metacarpal fractures. Although the current literature supports a wide array of treatment strategies, high-level evidence to guide fracture management remains lacking.
Topics: Evidence-Based Medicine; Fracture Fixation; Fractures, Bone; Humans; Metacarpal Bones
PubMed: 28654615
DOI: 10.1097/PRS.0000000000003470 -
Plastic and Reconstructive Surgery Sep 2015After studying this article, the participant should be able to: 1. Understand the indications for metacarpal fixation. 2. Understand the rationale for various surgical... (Review)
Review
LEARNING OBJECTIVES
After studying this article, the participant should be able to: 1. Understand the indications for metacarpal fixation. 2. Understand the rationale for various surgical treatment options, based on high-level evidence where available. 3. Describe selected operative techniques and their postoperative management.
BACKGROUND
Metacarpal fractures are extremely common, constituting one in five fractures that present to the emergency department. Although many metacarpal fractures can be treated nonoperatively, some require surgery. The purpose of this CME article is to present a practical, up-to-date guide to the management of these common injuries.
METHODS
A review of nonoperative management, surgical indications, and selected surgical techniques is provided. The authors reviewed the literature related to the treatment of metacarpal fractures, and the highest level evidence available to help guide decision-making is presented.
CONCLUSIONS
Metacarpal fractures can often be treated nonoperatively, although some fractures will benefit from surgical treatment. Although there is some high-level evidence to guide decision-making, there are many clinical scenarios for which there is little high-quality applicable research. As a general principle, the treatment option that achieves the desired reduction and degree of fixation, allows early motion, and minimizes soft-tissue injury should be preferred.
Topics: Fracture Fixation; Fractures, Bone; Hand Injuries; Humans; Metacarpal Bones; Postoperative Care; Radiography
PubMed: 26313842
DOI: 10.1097/PRS.0000000000001527 -
Hand Clinics Aug 2023Phalangeal and metacarpal fractures that require operative treatment have documented complications in around 50% of patients. The most common of these complications are... (Review)
Review
Phalangeal and metacarpal fractures that require operative treatment have documented complications in around 50% of patients. The most common of these complications are stiffness and malunion. These can be highly challenging problems for the hand surgeon. In this article, we discuss complications after phalangeal and metacarpal fractures and treatment strategies for these complications.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Hand Injuries; Fracture Fixation, Internal; Finger Phalanges
PubMed: 37453755
DOI: 10.1016/j.hcl.2023.02.002 -
FP Essentials Jan 2021Metacarpal fractures are common. Many metacarpal fractures without malrotation, particularly fifth metacarpal neck fractures, can be managed nonsurgically. However,...
Metacarpal fractures are common. Many metacarpal fractures without malrotation, particularly fifth metacarpal neck fractures, can be managed nonsurgically. However, intraarticular and extraarticular metacarpal fractures of the thumb are subject to tendon forces and often displace. Patients with such fractures require referral to an orthopedic surgery subspecialist for possible surgical intervention, as do patients with metacarpal fractures that have intraarticular involvement, malrotation, shortening greater than 6 mm, or excessive angulation.
Topics: Finger Injuries; Fractures, Bone; Humans; Metacarpal Bones
PubMed: 33433186
DOI: No ID Found -
Deutsches Arzteblatt International Dec 2023Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The... (Review)
Review
BACKGROUND
Fractures of the fingers and metacarpal bones are the most common fracture type in the upper limb, with an incidence of 114 to 1483 per 100 000 persons per year. The clinical importance of closed finger and metacarpal fractures is often underestimated; inadequate diagnostic and therapeutic measures may result in serious harm. This review concerns the basic elements of the diagnosis and treatment of finger and metacarpal fractures.
METHODS
This review of the incidence, diagnosis and treatment of finger and metacarpal fractures is based on pertinent publications retrieved by a selective search of the literature.
RESULTS
The main focus of treatment lies on restoration of hand function in consideration of the requirements of the individual patient. The currently available evidence provides little guidance to optimal treatment (level II evidence). Although most closed fractures can be managed conservatively, individualized surgical treatment is advisable in comminuted fractures and fractures with a relevant degree of torsional malposition, axis deviation, or shortening, as well as in intra-articular fractures. Minimally invasive techniques are, in principle, to be performed wherever possible, yet open surgery is sometimes needed because of fracture morphology. Postsurgical complication rates are in the range of 32-36%, with joint fusion accounting for 67-76% of the complications. 15% involve delayed fracture healing and pseudarthrosis.
CONCLUSION
Individualized treatment for finger and metacarpal fractures can improve patients' outcomes, with major socioeconomic and societal benefits. Further high-quality studies evaluating the relative merits of the available treatments are needed as a guide to optimized therapy.
Topics: Humans; Metacarpal Bones; Fractures, Bone; Hand Injuries; Fracture Fixation, Internal; Upper Extremity; Treatment Outcome
PubMed: 37963039
DOI: 10.3238/arztebl.m2023.0226