Metacarpal injuries

There are multiple named injuries of the metacarpal bones:

Bennet fracture is a partial intraarticular fracture of the base of the 1st metacarpal. Rolando fracture is a comminuted intraarticular fracture of the 1st metacarpal. They’re due to axial force on the thumb. Treatment is surgical.

Rolando fracture is a comminuted intraarticular fracture of the 1st metacarpal (multiple bone fragments).

Gamekeeper’s thumb is a torn medial collateral ligament of the thumb.

Boxer’s fracture is a fracture of the neck of the 5th metacarpal. Treatment may be conservative or surgical depending on the presence of dislocation or rotational malalignment.

Etiology

Bennet and Rolando fracture occurs due to axial force on the thumb, often sustained during a fist fight.

Gamekeeper thumb occurs due to abduction trauma of the MCP joint, for example due to fall while downhill skiing.

Like the name implies, a boxer’s fracture occurs due to direct trauma with closed fist to a hard object.

Clinical features

Typical fracture features. The patient must be examined for rotational malalignment.

Diagnosis and evaluation

X-ray.

Treatment

Fractures of the first metacarpal are treated surgically with ORIF and a cast.

Fractures of the fifth metacarpal may be treated conservatively or operatively, depending on whether there’s dislocation or not. In any case metacarpal fracture, if there is rotational malalignment, the patient should be considered for surgery.

Immobilisation of the hand requires fixation of it in a functional (resting) position with special casts. The exact position depends on the joint to be immobilised.

If one finger should be immobilised, it can often be fixated to the adjacent finger. As an example, for 5th metacarpal fractures, the 4th and 5th fingers are often fixated to each other for stability.