Non-thumb metacarpal fracture (neck) - Revision history

Rossdonaldson1: /* Management */

2019-09-18T02:52:50Z

Management

← Revisión anterior		Revisión del 02:52 18 sep 2019
Línea 26:		Línea 26:

	==Management==		==Management==
	*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]		{{General Fracture Management}}
	**MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.</ref>

	===Acute Reduction===		===Acute Reduction===
Línea 41:		Línea 40:

	{{Metacarpal fracture goals}}		{{Metacarpal fracture goals}}

			===Immobilization===
			*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]
			**MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.</ref>

	==Disposition==		==Disposition==

Rossdonaldson1: /* Acute Reduction */

2019-09-18T02:12:02Z

Acute Reduction

← Revisión anterior		Revisión del 02:12 18 sep 2019
Línea 39:		Línea 39:
	**[[Radial gutter splint]] if 2nd/3rd MCP fractures, [[Ulnar gutter splint]] if 4th/5th. Immobilize with wrist extended 20-30 degrees and MCP flexed 90 degrees		**[[Radial gutter splint]] if 2nd/3rd MCP fractures, [[Ulnar gutter splint]] if 4th/5th. Immobilize with wrist extended 20-30 degrees and MCP flexed 90 degrees
	**Can be difficult to reduce or maintain reduction. Early hand referral if not successful		**Can be difficult to reduce or maintain reduction. Early hand referral if not successful

			{{Metacarpal fracture goals}}

	==Disposition==		==Disposition==

Ted Fan: /* Management */ reduction technique

2017-04-14T18:12:27Z

Management: reduction technique

← Revisión anterior		Revisión del 18:12 14 abr 2017
Línea 31:		Línea 31:
	===Acute Reduction===		===Acute Reduction===
	*Acute reduction indicated:		*Acute reduction indicated:
	**~~Pseudoclawing~~		**Pseudo-clawing
	**~~Significantly angulated~~ 4th or 5th ~~MC fracture~~		**Significant angulation (>10-15 degrees of the 2nd through 4th fingers, 20-30 degrees of the 5th) <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref>
	**~~Rotational malalignment~~		**Any rotational misalignment
	*Reduction technique:		*Reduction technique:
	**Pain control and/or ~~hematoma~~ block		**Pain control and/or [[Hematoma block]]
	**Flex MCP joint then apply axial traction while placing pressure over metacarpal shaft		**Flex MCP joint to 90 degrees then apply axial traction while placing pressure over metacarpal shaft
			**[[Radial gutter splint]] if 2nd/3rd MCP fractures, [[Ulnar gutter splint]] if 4th/5th. Immobilize with wrist extended 20-30 degrees and MCP flexed 90 degrees
	**Can be difficult to reduce or maintain reduction. Early hand referral if not successful		**Can be difficult to reduce or maintain reduction. Early hand referral if not successful

Rossdonaldson1: /* Management */

2016-10-16T11:05:31Z

Management

← Revisión anterior		Revisión del 11:05 16 oct 2016
Línea 39:		Línea 39:
	**Can be difficult to reduce or maintain reduction. Early hand referral if not successful		**Can be difficult to reduce or maintain reduction. Early hand referral if not successful

	===Disposition===		==Disposition==
	*Outpatient		*Outpatient

Rossdonaldson1 at 11:05, 16 October 2016

2016-10-16T11:05:14Z

← Revisión anterior		Revisión del 11:05 16 oct 2016
Línea 1:		Línea 1:
	==~~Examination~~==		==Background==

			==Clinical Features==
	*TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture		*TTP or ecchymosis on the palmar bony surface is highly suggestive of fracture
	*Loss of the normal knuckle contour		*Loss of the normal knuckle contour
	**Due to dorsal angulation of fracture apex due to pull of the interosseous muscles		**Due to dorsal angulation of fracture apex due to pull of the interosseous muscles

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

			==Examination==
			*Hand xrays

			===Hand Examination===
	*Assess angulation<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 angulation<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>
	**Head-to-neck angle of the metacarpals is normally 15 degrees		**Head-to-neck angle of the metacarpals is normally 15 degrees
Línea 14:		Línea 24:
	*Assess extensor apparatus		*Assess extensor apparatus
	*Assess skin integrity		*Assess skin integrity

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

	==Management==		==Management==
	*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]]		*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]
	**MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.</ref>		**MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.</ref>

			===Acute Reduction===
	*Acute reduction indicated:		*Acute reduction indicated:
	**Pseudoclawing		**Pseudoclawing
Línea 30:		Línea 39:
	**Can be difficult to reduce or maintain reduction. Early hand referral if not successful		**Can be difficult to reduce or maintain reduction. Early hand referral if not successful

	===~~Dispoition~~===		===Disposition===
	*Refer for:		*Outpatient
	**Comminution
	**Rotational malalignment		===Refer for===
	**Unsuccessful reduction if required<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>		*Comminution
			*Rotational malalignment
			*Unsuccessful reduction if required<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>

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

Rossdonaldson1 at 11:02, 16 October 2016

2016-10-16T11:02:22Z

← Revisión anterior		Revisión del 11:02 16 oct 2016
Línea 3:		Línea 3:
	*Loss of the normal knuckle contour		*Loss of the normal knuckle contour
	**Due to dorsal angulation of fracture apex due to pull of the interosseous muscles		**Due to dorsal angulation of fracture apex due to pull of the interosseous muscles
	*Assess angulation		*Assess angulation<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>
	**Head-to-neck angle of the metacarpals is normally 15 degrees		**Head-to-neck angle of the metacarpals is normally 15 degrees
	***Fracture angulation = measured angle minus 15 deg		***Fracture angulation = measured angle minus 15 deg
Línea 34:		Línea 34:
	**Comminution		**Comminution
	**Rotational malalignment		**Rotational malalignment
	**Unsuccessful reduction if required		**Unsuccessful reduction if required<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>

	==See Also==		==See Also==
Línea 41:		Línea 41:
	==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]]

Ted Fan: ref added

2016-10-11T13:32:06Z

ref added

← Revisión anterior		Revisión del 13:32 11 oct 2016
Línea 41:		Línea 41:
	==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]]

Ted Fan: added reduction technique, other detail

2016-10-11T13:30:15Z

added reduction technique, other detail

← Revisión anterior		Revisión del 13:30 11 oct 2016
Línea 24:		Línea 24:
	**Pseudoclawing		**Pseudoclawing
	**Significantly angulated 4th or 5th MC fracture		**Significantly angulated 4th or 5th MC fracture
			**Rotational malalignment
			*Reduction technique:
			**Pain control and/or hematoma block
			**Flex MCP joint then apply axial traction while placing pressure over metacarpal shaft
			**Can be difficult to reduce or maintain reduction. Early hand referral if not successful

	===Dispoition===		===Dispoition===
Línea 29:		Línea 34:
	**Comminution		**Comminution
	**Rotational malalignment		**Rotational malalignment
			**Unsuccessful reduction if required

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

Rossdonaldson1: Text replacement - "fx" to "fracture"

2016-07-08T18:01:33Z

Text replacement - "fx" to "fracture"

← Revisión anterior		Revisión del 18:01 8 jul 2016
Línea 23:		Línea 23:
	*Acute reduction indicated:		*Acute reduction indicated:
	**Pseudoclawing		**Pseudoclawing
	**Significantly angulated 4th or 5th MC fx		**Significantly angulated 4th or 5th MC fracture

	===Dispoition===		===Dispoition===

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-07T23:27:42Z

Text replacement - "==Treatment==" to "==Management=="

← Revisión anterior		Revisión del 23:27 7 jul 2016
Línea 18:		Línea 18:
	{{Hand and finger fractures DDX}}		{{Hand and finger fractures DDX}}

	==~~Treatment~~==		==Management==
	*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]]		*[[Ulnar Gutter Splint]] or [[Radial Gutter Splint]]]
	**MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.</ref>		**MCP joints in 70-90 deg flexion, wrist in 20-30 deg extension, PIP and DIP joints in 5-10 deg of flexion<ref>Hofmeister, EP. Comparison of 2 methods of immobilization of fifth metacarpal neck fractures: a prospective randomized study. The Journal of Hand Surgery. 2008; 33(8):1362-1368.</ref>