Advertisement

Injury-Fractures-Carpo-Metacarpal Joint and Metacarpal

  • Chye Yew NgEmail author
  • Michael J. Hayton
Chapter

Abstract

Metacarpal fractures are extremely common and, after distal radial fractures, are the second most common fracture treated by an orthopaedic surgeon [1]. The annual incidence has been estimated at 130/105 population/year, with a male to female ratio of 85:15 [1]. The majority of fractures do not require surgical intervention and can be treated adequately with immobilisation or protective splinting. Irreducible or unstable fracture patterns warrant special attention and fixation to prevent long-term problems. As these fractures present with an average age of 29.9 years [1], any morbidity and loss of function as a consequence of inadequate treatment or surgical complications could have a significant socioeconomic impact.

Keywords

Metacarpal Carpometacarpal joint Trapeziometacarpal joint Fracture Fracture-dislocation Joint dislocation Rotational deformity Intra-articular Bennett’s fracture Rolando’s fracture Malunion 

References

  1. 1.
    Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37:691–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Lazar G, Schulter-Ellis FP. Intramedullary structure of human metacarpals. J Hand Surg Am. 1980;5:477–81.PubMedCrossRefGoogle Scholar
  3. 3.
    Kozin SH, Thoder JJ, Lieberman G. Operative treatment of metacarpal and phalangeal shaft fractures. J Am Acad Orthop Surg. 2000;8:111–21.PubMedGoogle Scholar
  4. 4.
    Strauch RJ, Rosenwasser MP, Lunt JG. Metacarpal shaft fractures: the effect of shortening on the extensor tendon mechanism. J Hand Surg Am. 1998;23:519–23.PubMedCrossRefGoogle Scholar
  5. 5.
    Al-Qattan MM. Outcome of conservative management of spiral/long oblique fractures of the metacarpal shaft of the fingers using a palmar wrist splint and immediate mobilisation of the fingers. J Hand Surg Eur Vol. 2008;33:723–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Low CK, Wong HC, Low YP, et al. A cadaver study of the effects of dorsal angulation and shortening of the metacarpal shaft on the extension and flexion force ratios of the index and little fingers. J Hand Surg Br. 1995;20:609–13.PubMedCrossRefGoogle Scholar
  7. 7.
    Blair WF, Steyers CM. Techniques in hand surgery. Baltimore: Williams & Wilkins; 1996.Google Scholar
  8. 8.
    Birndorf MS, Daley R, Greenwald DP. Metacarpal fracture angulation decreases flexor mechanical efficiency in human hands. Plast Reconstr Surg. 1997;99:1079–83; discussion 84–5.PubMedCrossRefGoogle Scholar
  9. 9.
    Royle SG. Rotational deformity following metacarpal fracture. J Hand Surg Br. 1990;15:124–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Lee SG, Jupiter JB. Phalangeal and metacarpal fractures of the hand. Hand Clin. 2000;16:323–32, vii.PubMedGoogle Scholar
  11. 11.
    Thurston AJ. Pivot osteotomy for the correction of malunion of metacarpal neck fractures. J Hand Surg Br. 1992;17:580–2.PubMedCrossRefGoogle Scholar
  12. 12.
    Brewerton DA. A tangential radiographic projection for demonstrating involvement of metacarpal heads in rheumatoid arthritis. Br J Radiol. 1967;40:233–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Eyres KS, Allen TR. Skyline view of the metacarpal head in the assessment of human fight-bite injuries. J Hand Surg Br. 1993;18:43–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br. 1987;69:212–4.PubMedGoogle Scholar
  15. 15.
    Hodgson PD, Shewring DJ. The ‘metacarpal cascade lines’; use in the diagnosis of dislocations of the carpometacarpal joints. J Hand Surg Eur Vol. 2007;32:277–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Mehara AK, Bhan S. Rotatory dislocation of the second carpometacarpal joint: case report. J Trauma. 1993;34:464–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Page SM, Stern PJ. Complications and range of motion following plate fixation of metacarpal and phalangeal fractures. J Hand Surg Am. 1998;23:827–32.PubMedCrossRefGoogle Scholar
  18. 18.
    McElfresh EC, Dobyns JH. Intra-articular metacarpal head fractures. J Hand Surg Am. 1983;8:383–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Shewring DJ, Thomas RH. Collateral ligament avulsion fractures from the heads of the metacarpals of the fingers. J Hand Surg Br. 2006;31:537–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Anakwe RE, Aitken SA, Cowie JG, et al. The epidemiology of fractures of the hand and the influence of social deprivation. J Hand Surg Eur Vol. 2011;36:62–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Kilbourne BC. Management of complicated hand fractures. Surg Clin North Am. 1968;48:201–13.Google Scholar
  22. 22.
    Bloem JJ. The treatment and prognosis of uncomplicated dislocated fractures of the metacarpals and phalanges. Arch Chir Neerl. 1971;23:55–65.PubMedGoogle Scholar
  23. 23.
    Eichenholtz SN, Rizzo 3rd PC. Fracture of the neck of the fifth metacarpal bone – is over-treatment justified? JAMA. 1961;178:425–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Hunter JM, Cowen NJ. Fifth metacarpal fractures in a compensation clinic population. A report on one hundred and thirty-three cases. J Bone Joint Surg Am. 1970;52:1159–65.PubMedGoogle Scholar
  25. 25.
    Ford DJ, Ali MS, Steel WM. Fractures of the fifth metacarpal neck: is reduction or immobilisation necessary? J Hand Surg Br. 1989;14:165–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Statius Muller MG, Poolman RW, van Hoogstraten MJ, et al. Immediate mobilization gives good results in boxer’s fractures with volar angulation up to 70 degrees: a prospective randomized trial comparing immediate mobilization with cast immobilization. Arch Orthop Trauma Surg. 2003;123:534–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Leung YL, Beredjiklian PK, Monaghan BA, et al. Radiographic assessment of small finger metacarpal neck fractures. J Hand Surg Am. 2002;27:443–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Breddam M, Hansen TB. Subcapital fractures of the fourth and fifth metacarpals treated without splinting and reposition. Scand J Plast Reconstr Surg Hand Surg. 1995;29:269–70.PubMedCrossRefGoogle Scholar
  29. 29.
    Bansal R, Craigen MA. Fifth metacarpal neck fractures: is follow-up required? J Hand Surg Eur Vol. 2007;32:69–73.PubMedCrossRefGoogle Scholar
  30. 30.
    Konradsen L, Nielsen PT, Albrecht-Beste E. Functional treatment of metacarpal fractures 100 randomized cases with or without fixation. Acta Orthop Scand. 1990;61:531–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Braakman M, Oderwald EE, Haentjens MH. Functional taping of fractures of the 5th metacarpal results in a quicker recovery. Injury. 1998;29:5–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Harding IJ, Parry D, Barrington RL. The use of a moulded metacarpal brace versus neighbour strapping for fractures of the little finger metacarpal neck. J Hand Surg Br. 2001;26:261–3.PubMedCrossRefGoogle Scholar
  33. 33.
    Lowdon IM. Fractures of the metacarpal neck of the little finger. Injury. 1986;17:189–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Lamb DW, Abernethy PA, Raine PA. Unstable fractures of the metacarpals. A method of treatment by transverse wire fixation to intact metacarpals. Hand. 1973;5:43–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Galanakis I, Aligizakis A, Katonis P, et al. Treatment of closed unstable metacarpal fractures using percutaneous transverse fixation with Kirschner wires. J Trauma. 2003;55:509–13.PubMedCrossRefGoogle Scholar
  36. 36.
    Foucher G. “Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995;20:S86–90.PubMedCrossRefGoogle Scholar
  37. 37.
    Wong TC, Ip FK, Yeung SH. Comparison between percutaneous transverse fixation and intramedullary K-wires in treating closed fractures of the metacarpal neck of the little finger. J Hand Surg Eur Vol. 2006;31:61–5.CrossRefGoogle Scholar
  38. 38.
    Winter M, Balaguer T, Bessiere C, et al. Surgical treatment of the boxer’s fracture: transverse pinning versus intramedullary pinning. J Hand Surg Eur Vol. 2007;32:709–13.PubMedCrossRefGoogle Scholar
  39. 39.
    Facca S, Ramdhian R, Pelissier A, et al. Fifth metacarpal neck fracture fixation: locking plate versus K-wire? Orthop Traumatol Surg Res. 2010;96:506–12.PubMedCrossRefGoogle Scholar
  40. 40.
    Strub B, Schindele S, Sonderegger J, et al. Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur Vol. 2010;35:725–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Viegas SF, Tencer A, Woodard P, et al. Functional bracing of fractures of the second through fifth metacarpals. J Hand Surg Am. 1987;12:139–43.PubMedCrossRefGoogle Scholar
  42. 42.
    Geiger KR, Karpman RR. Necrosis of the skin over the metacarpal as a result of functional fracture-bracing. A report of three cases. J Bone Joint Surg Am. 1989;71:1199–202.PubMedGoogle Scholar
  43. 43.
    McMahon PJ, Woods DA, Burge PD. Initial treatment of closed metacarpal fractures. A controlled comparison of compression glove and splintage. J Hand Surg Br. 1994;19:597–600.PubMedCrossRefGoogle Scholar
  44. 44.
    Bosscha K, Snellen JP. Internal fixation of metacarpal and phalangeal fractures with AO minifragment screws and plates: a prospective study. Injury. 1993;24:166–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Grundberg AB. Intramedullary fixation for fractures of the hand. J Hand Surg Am. 1981;6:568–73.PubMedCrossRefGoogle Scholar
  46. 46.
    Al-Qattan MM. Metacarpal shaft fractures of the fingers: treatment with interosseous loop wire fixation and immediate postoperative finger mobilisation in a wrist splint. J Hand Surg Br. 2006;31:377–82.PubMedCrossRefGoogle Scholar
  47. 47.
    Al-Qattan MM, Al-Lazzam A. Long oblique/spiral mid-shaft metacarpal fractures of the fingers: treatment with cerclage wire fixation and immediate post-operative finger mobilisation in a wrist splint. J Hand Surg Eur Vol. 2007;32:637–40.PubMedCrossRefGoogle Scholar
  48. 48.
    Al-Qattan MM, Al-Zahrani K, Al-Arfaj N, et al. A modified technique of dental wire fixation for spiral/oblique metacarpal and phalangeal fractures of the fingers. J Hand Surg Eur Vol. 2010;35:325–6.PubMedCrossRefGoogle Scholar
  49. 49.
    Manueddu CA, Della Santa D. Fasciculated intramedullary pinning of metacarpal fractures. J Hand Surg Br. 1996;21:230–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Faraj AA, Davis TR. Percutaneous intramedullary fixation of metacarpal shaft fractures. J Hand Surg Br. 1999;24:76–9.PubMedCrossRefGoogle Scholar
  51. 51.
    Dickson RA. Rigid fixation of unstable metacarpal fractures using transverse K-wires bonded with acrylic resin. Hand. 1975;7:284–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Shehadi SI. External fixation of metacarpal and phalangeal fractures. J Hand Surg Am. 1991;16:544–50.PubMedCrossRefGoogle Scholar
  53. 53.
    Gonzalez MH, Hall Jr RF. Intramedullary fixation of metacarpal and proximal phalangeal fractures of the hand. Clin Orthop Relat Res. 1996;327:47–54.Google Scholar
  54. 54.
    Nordyke MD, Lewis Jr RC, Janssen HF, et al. Biomechanical and clinical evaluation of the expandable intramedullary fixation device. J Hand Surg Am. 1988;13:128–34.PubMedCrossRefGoogle Scholar
  55. 55.
    Ochman S, Doht S, Paletta J, et al. Comparison between locking and non-locking plates for fixation of metacarpal fractures in an animal model. J Hand Surg Am. 2010;35:597–603.PubMedCrossRefGoogle Scholar
  56. 56.
    Ozer K, Gillani S, Williams A, et al. Comparison of intramedullary nailing versus plate-screw fixation of extra-articular metacarpal fractures. J Hand Surg Am. 2008;33:1724–31.PubMedCrossRefGoogle Scholar
  57. 57.
    Liaw Y, Kalnins G, Kirsh G, et al. Combined fourth and fifth metacarpal fracture and fifth carpometacarpal joint dislocation. J Hand Surg Br. 1995;20:249–52.PubMedCrossRefGoogle Scholar
  58. 58.
    Chong AK, Chew WY. An isolated ring finger metacarpal shaft fracture? – beware an associated little finger carpometacarpal joint dislocation. J Hand Surg Br. 2004;29:629–31.PubMedCrossRefGoogle Scholar
  59. 59.
    Peterson P, Sacks S. Fracture-dislocation of the base of the fifth metacarpal associated with injury to the deep motor branch of the ulnar nerve: a case report. J Hand Surg Am. 1986;11:525–8.PubMedCrossRefGoogle Scholar
  60. 60.
    O’Rourke PJ, Quinlan W. Fracture dislocation of the fifth metacarpal resulting in compression of the deep branch of the ulnar nerve. J Hand Surg Br. 1993;18:190–1.PubMedCrossRefGoogle Scholar
  61. 61.
    Petrie PW, Lamb DW. Fracture-subluxation of base of fifth metacarpal. Hand. 1974;6:82–6.PubMedCrossRefGoogle Scholar
  62. 62.
    Kjaer-Petersen K, Jurik AG, Petersen LK. Intra-articular fractures at the base of the fifth metacarpal. A clinical and radiographical study of 64 cases. J Hand Surg Br. 1992;17:144–7.PubMedCrossRefGoogle Scholar
  63. 63.
    Kumar R, Malhotra R. Divergent fracture-dislocation of the second carpometacarpal joint and the three ulnar carpometacarpal joints. J Hand Surg Am. 2001;26:123–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Agarwal A, Agarwal R. An unusual farm injury: divergent carpometacarpal joint dislocations. J Hand Surg Br. 2005;30:633–4.PubMedCrossRefGoogle Scholar
  65. 65.
    Garcia-Elias M, Bishop AT, Dobyns JH, et al. Transcarpal carpometacarpal dislocations, excluding the thumb. J Hand Surg Am. 1990;15:531–40.PubMedCrossRefGoogle Scholar
  66. 66.
    Lundeen JM, Shin AY. Clinical results of intraarticular fractures of the base of the fifth metacarpal treated by closed reduction and cast immobilization. J Hand Surg Br. 2000;25:258–61.PubMedCrossRefGoogle Scholar
  67. 67.
    Day CS, Stern PJ. Fractures of the metacarpals and phalanges. In: Wolfe SC, Hotchkiss RN, Pederson WC, Kozin SH, editors. Green’s operative hand surgery, vol. 1. 6th ed. Philadelphia: Churchill Livingstone; 2011.Google Scholar
  68. 68.
    Bennett EI. Fractures of the metacarpal bones. Dublin J Med Sci. 1882;73:72–5.Google Scholar
  69. 69.
    Henry MH. Fractures and dislocations of the hand. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green’s fractures in adults, vol. 1. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 823–55.Google Scholar
  70. 70.
    Wagner CJ. Method of treatment of Bennett’s fracture dislocation. Am J Surg. 1950;80:230–1.PubMedCrossRefGoogle Scholar
  71. 71.
    Johnson EC. Fracture of the base of the thumb. A new method of fixation. JAMA. 1944;126:27–8.CrossRefGoogle Scholar
  72. 72.
    Cannon SR, Dowd GS, Williams DH, et al. A long-term study following Bennett’s fracture. J Hand Surg Br. 1986;11:426–31.PubMedCrossRefGoogle Scholar
  73. 73.
    Kjaer-Petersen K, Langhoff O, Andersen K. Bennett’s fracture. J Hand Surg Br. 1990;15:58–61.PubMedCrossRefGoogle Scholar
  74. 74.
    Livesley PJ. The conservative management of Bennett’s fracture-dislocation: a 26-year follow-up. J Hand Surg Br. 1990;15:291–4.PubMedCrossRefGoogle Scholar
  75. 75.
    Lutz M, Sailer R, Zimmermann R, et al. Closed reduction transarticular Kirschner wire fixation versus open reduction internal fixation in the treatment of Bennett’s fracture dislocation. J Hand Surg Br. 2003;28:142–7.PubMedCrossRefGoogle Scholar
  76. 76.
    Rolando S. Fracture de la base du premier metacarpien et principa ement sur une variété non encore décrite. Presse Med. 1910;18:303.Google Scholar
  77. 77.
    Langhoff O, Andersen K, Kjaer-Petersen K. Rolando’s fracture. J Hand Surg Br. 1991;16:454–9.PubMedCrossRefGoogle Scholar
  78. 78.
    Gelberman RH, Vance RM, Zakaib GS. Fractures at the base of the thumb: treatment with oblique traction. J Bone Joint Surg Am. 1979;61:260–2.PubMedGoogle Scholar
  79. 79.
    Buchler U, McCollam SM, Oppikofer C. Comminuted fractures of the basilar joint of the thumb: combined treatment by external fixation, limited internal fixation, and bone grafting. J Hand Surg Am. 1991;16:556–60.PubMedCrossRefGoogle Scholar
  80. 80.
    Foster RJ, Hastings 2nd H. Treatment of Bennett, Rolando, and vertical intraarticular trapezial fractures. Clin Orthop Relat Res. 1987;214:121–9.Google Scholar
  81. 81.
    Watt N, Hooper G. Dislocation of the trapezio-metacarpal joint. J Hand Surg Br. 1987;12:242–5.PubMedCrossRefGoogle Scholar
  82. 82.
    Strauch RJ, Behrman MJ, Rosenwasser MP. Acute dislocation of the carpometacarpal joint of the thumb: an anatomic and cadaver study. J Hand Surg Am. 1994;19:93–8.PubMedCrossRefGoogle Scholar
  83. 83.
    Shah J, Patel M. Dislocation of the carpometacarpal joint of the thumb. A report of four cases. Clin Orthop Relat Res. 1983;175:166–9.Google Scholar
  84. 84.
    Simonian PT, Trumble TE. Traumatic dislocation of the thumb carpometacarpal joint: early ligamentous reconstruction versus closed reduction and pinning. J Hand Surg Am. 1996;21:802–6.PubMedCrossRefGoogle Scholar
  85. 85.
    Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973;55:1655–66.PubMedGoogle Scholar
  86. 86.
    McLain RF, Steyers C, Stoddard M. Infections in open fractures of the hand. J Hand Surg Am. 1991;16:108–12.PubMedCrossRefGoogle Scholar
  87. 87.
    Swanson TV, Szabo RM, Anderson DD. Open hand fractures: prognosis and classification. J Hand Surg Am. 1991;16:101–7.PubMedCrossRefGoogle Scholar
  88. 88.
    Ouellette EA, Freeland AE. Use of the minicondylar plate in metacarpal and phalangeal fractures. Clin Orthop Relat Res. 1996;327:38–46.Google Scholar
  89. 89.
    Stern PJ, Wieser MJ, Reilly DG. Complications of plate fixation in the hand skeleton. Clin Orthop Relat Res. 1987;214:59–65.Google Scholar
  90. 90.
    O’Sullivan ST, Limantzakis G, Kay SP. The role of low-profile titanium miniplates in emergency and elective hand surgery. J Hand Surg Br. 1999;24:347–9.PubMedCrossRefGoogle Scholar
  91. 91.
    Saint-Cyr M, Miranda D, Gonzalez R, et al. Immediate corticocancellous bone autografting in segmental bone defects of the hand. J Hand Surg Br. 2006;31:168–77.PubMedCrossRefGoogle Scholar
  92. 92.
    Stahl S, Lerner A, Kaufman T. Immediate autografting of bone in open fractures with bone loss of the hand: a preliminary report. Case reports. Scand J Plast Reconstr Surg Hand Surg. 1999;33:117–22.PubMedCrossRefGoogle Scholar
  93. 93.
    Flatt AE. Closed and open fractures of the hand. Fundamentals of management. Postgrad Med. 1966;39:17–26.PubMedGoogle Scholar
  94. 94.
    Westbrook AP, Davis TR, Armstrong D, et al. The clinical significance of malunion of fractures of the neck and shaft of the little finger metacarpal. J Hand Surg Eur Vol. 2008;33:732–9.PubMedCrossRefGoogle Scholar
  95. 95.
    Manktelow RT, Mahoney JL. Step osteotomy: a precise rotation osteotomy to correct scissoring deformities of the fingers. Plast Reconstr Surg. 1981;68:571–6.PubMedCrossRefGoogle Scholar
  96. 96.
    Gross MS, Gelberman RH. Metacarpal rotational osteotomy. J Hand Surg Am. 1985;10:105–8.PubMedCrossRefGoogle Scholar
  97. 97.
    Kuokkanen HO, Mulari-Keranen SK, Niskanen RO, et al. Treatment of subcapital fractures of the fifth metacarpal bone: a prospective randomised comparison between functional treatment and reposition and splinting. Scand J Plast Reconstr Surg Hand Surg. 1999;33:315–7.PubMedCrossRefGoogle Scholar
  98. 98.
    Waris E, Ashammakhi N, Kaarela O, et al. Use of bioabsorbable osteofixation devices in the hand. J Hand Surg Br. 2004;29:590–8.PubMedCrossRefGoogle Scholar
  99. 99.
    Bozic KJ, Perez LE, Wilson DR, et al. Mechanical testing of bioresorbable implants for use in metacarpal fracture fixation. J Hand Surg Am. 2001;26:755–61.PubMedCrossRefGoogle Scholar
  100. 100.
    Jensen CH, Jensen CM. Biodegradable pins versus Kirschner wires in hand surgery. J Hand Surg Br. 1996;21:507–10.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Consultant Hand and Peripheral Nerve SurgeonUpper Limb Unit, Wrightington HospitalWiganUK

Personalised recommendations