Non-thumb metacarpal fracture (head) - Revision history

Rossdonaldson1: /* Management */

2019-09-18T02:51:59Z

Management

← Revisión anterior		Revisión del 02:51 18 sep 2019
Línea 19:		Línea 19:

	==Management==		==Management==
			{{General Fracture Management}}

			===Specific Management===
	*[[Ulnar Gutter Splint]] or Short arm cast that extends to the PIP joint		*[[Ulnar Gutter Splint]] or Short arm cast that extends to the PIP joint
	**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>		**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>

Rossdonaldson1: /* Disposition */

2019-09-18T02:22:47Z

Disposition

← Revisión anterior		Revisión del 02:22 18 sep 2019
Línea 27:		Línea 27:
	*Dorsal MCP wounds and lacerations should be treated as open and contaminated<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>		*Dorsal MCP wounds and lacerations should be treated as open and contaminated<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
	*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises		*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises

			===Indications for Subsequent Out-Patient Orthopedic Surgery===
			*Majority are operative, as no degree of articular displacement is acceptable

	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2019-09-18T02:13:20Z

Management

← Revisión anterior		Revisión del 02:13 18 sep 2019
Línea 22:		Línea 22:
	**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>		**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>
	*Remove restrictive clothing, jewelry, etc.		*Remove restrictive clothing, jewelry, etc.

	~~{{Metacarpal fracture goals}}~~

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2019-09-18T02:11:43Z

Management

← Revisión anterior		Revisión del 02:11 18 sep 2019
Línea 22:		Línea 22:
	**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>		**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>
	*Remove restrictive clothing, jewelry, etc.		*Remove restrictive clothing, jewelry, etc.

			{{Metacarpal fracture goals}}

	==Disposition==		==Disposition==

Rossdonaldson1 at 12:19, 16 October 2016

2016-10-16T12:19:29Z

← Revisión anterior		Revisión del 12:19 16 oct 2016
Línea 2:		Línea 2:
	*Intra-articular fracture		*Intra-articular fracture

	==~~Examination~~==		==Clinical Features==
	*Swelling, decreased ROM, and TTP of MCP joint		*Swelling, decreased ROM, and TTP of MCP joint

			==Differential Diagnosis==
			{{Hand and finger fractures DDX}}

			==Evaluation==
			===Physical===
	*Assess for rotational alignment (rotational malalignment is not tolerated)		*Assess for rotational alignment (rotational malalignment is not tolerated)
	*Assess for skin integrity (maintain high index of suspicion for [[Closed fist infection]])<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>		*Assess for skin integrity (maintain high index of suspicion for [[Closed fist infection]])<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
Línea 11:		Línea 17:
	**Angulation assessed on lateral view		**Angulation assessed on lateral view
	*Consider "[[Brewerton view (X-Ray)]]" if collateral ligament avulsion fracture suspected		*Consider "[[Brewerton view (X-Ray)]]" if collateral ligament avulsion fracture suspected

	~~==Differential Diagnosis==~~
	~~{{Hand and finger fractures DDX}}~~

	==Management==		==Management==

Rossdonaldson1: /* References */

2016-10-16T12:18:30Z

References

← Revisión anterior		Revisión del 12:18 16 oct 2016
Línea 32:		Línea 32:
	==References==		==References==
	<references/>		<references/>
	*German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.

	[[Category:Orthopedics]]		[[Category:Orthopedics]]

Rossdonaldson1: /* Examination */

2016-10-16T12:18:16Z

Examination

← Revisión anterior		Revisión del 12:18 16 oct 2016
Línea 5:		Línea 5:
	*Swelling, decreased ROM, and TTP of MCP joint		*Swelling, decreased ROM, and TTP of MCP joint
	*Assess for rotational alignment (rotational malalignment is not tolerated)		*Assess for rotational alignment (rotational malalignment is not tolerated)
	*Assess for skin integrity (maintain high index of suspicion for [[Closed fist infection]])		*Assess for skin integrity (maintain high index of suspicion for [[Closed fist infection]])<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>

	==Imaging==		==Imaging==

Rossdonaldson1: /* Disposition */

2016-10-16T12:18:05Z

Disposition

← Revisión anterior		Revisión del 12:18 16 oct 2016
Línea 21:		Línea 21:

	==Disposition==		==Disposition==
	*Almost always refer ~~b/c~~ are intraarticular and typically comminuted		*Almost always refer because are intraarticular and typically comminuted
	*Dorsal MCP wounds and lacerations should be treated as open and contaminated<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>		*Dorsal MCP wounds and lacerations should be treated as open and contaminated<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
	*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises		*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises

Rossdonaldson1: /* Disposition */

2016-10-16T12:17:53Z

Disposition

← Revisión anterior		Revisión del 12:17 16 oct 2016
Línea 22:		Línea 22:
	==Disposition==		==Disposition==
	*Almost always refer b/c are intraarticular and typically comminuted		*Almost always refer b/c are intraarticular and typically comminuted
	*Dorsal MCP wounds and lacerations should be treated as open and contaminated		*Dorsal MCP wounds and lacerations should be treated as open and contaminated<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
	*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises		*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises

Ted Fan: additional detail, linked to fight bite page

2016-10-11T01:17:33Z

additional detail, linked to fight bite page

← Revisión anterior		Revisión del 01:17 11 oct 2016
Línea 5:		Línea 5:
	*Swelling, decreased ROM, and TTP of MCP joint		*Swelling, decreased ROM, and TTP of MCP joint
	*Assess for rotational alignment (rotational malalignment is not tolerated)		*Assess for rotational alignment (rotational malalignment is not tolerated)
	*Assess for skin integrity (~~rule out fight bite~~)		*Assess for skin integrity (maintain high index of suspicion for [[Closed fist infection]])

	==Imaging==		==Imaging==
Línea 18:		Línea 18:
	*[[Ulnar Gutter Splint]] or Short arm cast that extends to the PIP joint		*[[Ulnar Gutter Splint]] or Short arm cast that extends to the PIP joint
	**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>		**In a comparison of the typical 4th and 5th digit flexed at the MCP joint and a short arm, there was no significant benefit to the intrinsic plus position of the fingers<ref>http://dx.doi.org/10.1016/j.jhsa.2008.04.010.</ref>
			*Remove restrictive clothing, jewelry, etc.

	==Disposition==		==Disposition==
	*Almost always refer b/c are intraarticular and typically comminuted		*Almost always refer b/c are intraarticular and typically comminuted
			*Dorsal MCP wounds and lacerations should be treated as open and contaminated
	*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises		*Non-displaced fracture can be splinted for 2-3 weeks followed by ROM exercises

Línea 26:		Línea 28:
	*[[Hand and finger fractures]]		*[[Hand and finger fractures]]
	*[[Boxer's fracture]]		*[[Boxer's fracture]]
			*[[Closed fist infection]]

	==References==		==References==
	<references/>		<references/>
			*German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.

	[[Category:Orthopedics]]		[[Category:Orthopedics]]