8/27/2023 0 Comments Define meta in metacarpal![]() The fracture may also result in a malrotation of the fracture, leading to scissoring or overlap of the fingers on flexion. 8 The extension may also be affected, with development of a compensatory metacarpophalangeal (MCP) joint hyperextension and proximal interphalangeal (PIP) joint flexion, called a pseudo-clawing of the finger ( Fig. 23.2), a weakness of flexion force may result as the flexors become relatively too long for the finger. ![]() Because of shortening of the metacarpal bone ( Fig. 23.4), and a hard lump may be felt in the palm. 7 The direct blow causing the fracture results in an additionally volarly flexed position of the metacarpal neck. The neck of the metacarpals has a normal volar angulation of 14 degrees. The metacarpals are concave in the sagittal plane and relatively flat on the dorsal side. The hand may swell, and a discoloration and/or bruising of the affected area may be seen. There may be pain with movement of the fingers. The typical symptoms of a metacarpal neck fracture are pain and tenderness localized around the knuckle. This definition is used in the authors’ later randomized controlled trial (RCT) where a functional treatment is compared with bouquet pinning. 23.3) and that 75% or more of the fracture line should be distal to the proximal border of the neck area. Based on this study, the authors showed that the metacarpal neck area is best defined as the squared distance between the insertions of the collateral ligaments in the metacarpal head ( Fig. In a study of Sletten et al, 5 the validity and reliability of nine different neck fracture definitions were tested against expert opinion, using a logistic regression and inter- and intraobserver coefficient. 4 The implementation of this definition in metacarpal neck fractures is, however, difficult. The Orthopaedic Trauma Association (OTA) divides the metacarpals into distal, shaft, and proximal segments. This may have contributed to difficulties in comparing results of different studies. 23.2), the transition zone between the shaft and the distal segment has not been uniformly defined and used. Although angulation of the metacarpal neck results in less shortening than angulation of the metacarpal shaft ( Fig. There are no definitions commonly used in the literature for metacarpal neck fractures. The injury usually occurs in association with alcohol intake and violence. The direct blow is causing a longitudinal compression through the knuckle, resulting in a fracture of the neck of the metacarpal ( Fig. The small finger metacarpal neck fractures occur most often in brawlers, who impulsively hit a solid object or another person with a closed fist. This is a misnomer, as fractures in professional boxers usually occur in the metacarpal neck of the index finger. 1 The small finger metacarpal neck fracture is often called boxer’s fracture. 1– 3 The index, middle, and ring finger metacarpal neck fractures account for 6, 2, and 5% of all metacarpal fractures, respectively. They occur most often in the small finger metacarpals, which account for 10% of all hand fractures 1 and 25 to 36% of all metacarpal fractures. Metacarpal neck fractures are common fractures. Keywords: metacarpal neck fracture, boxer’s fracture, definition of metacarpal neck, measurement of angulation and shortening, conservative treatment, operative treatment, evidence Less angulation is accepted for the other metacarpal necks, with as less as 15 to 20 degrees for the second and third metacarpal to as much as 30 to 40 degrees for the forth metacarpal. Antegrade intramedullary (bouquet) pinning is a good method of choice, and allows for immediate mobilization. Operative treatment should be considered for fractures with rotational malalignment or pseudo-clawing of the small finger. Fractures with angulation of more than 50 to 70 degrees are few. The initial treatment may, however, be in a cast for a few days until pain settles, and then followed by mobilization with a buddy strap to the ring finger. Using functional treatment, no reduction should be performed, as the mobilization depends on the stability of an impacted fracture. The literature suggests that fractures of small finger metacarpal neck of less than 50 to 70 degrees of volar angulation may be best treated conservatively with early mobilization, although there is weakness in existing literature due to heterogeneity of the data. The degree of acceptable deformity depends on which metacarpal is involved. Controversy exists regarding choice of treatment, but majority of metacarpal neck fractures respond well to conservative management. The small finger metacarpals are most frequently involved, and account for around one-fourth to one-third of all metacarpal fractures. Fractures of the metacarpal neck are common injuries.
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