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Metacarpal Base Fracture S62.319A 815.02

 

synonyms: metacarpal fracture

Metacarpal Base Fracture ICD-9

Metacarpal Base Fracture ICD-9

  • 815.02 Fracture of metacarpal bone; closed, base of other metacarpal bone
  • 815.12 Fracture of metacarpal bone; open, base of other metacarpal bone

Metacarpal Base Fracture Etiology / Epidemiology / Natural History

Metacarpal Base Fracture Anatomy

  •  metacarpals are concave on the palmar surface, thus plates should be pre-bent to avoid volar gaping at the fracture site.
  • 2nd and 3rd metacarpals articulate with the trapezoid and capitate. Limited motion exists in 2nd, 3rd CMC joints.
  • 4th and 5th metacarpals articulate with the hamate and have greater
  • intermetacarpal ligament prevent more than 3-4mm of shortening. (Eglseder WA, JOT 1997:11:441)
  • 7degree extensor lag develops for every 2mm of metacarpal shortening. (Strauch RJ, J Hand Surg 1998;23Am:519)

Metacarpal Base Fracture Clinical Evaluation

  •  evaluate cascade, any scissoring or overlap indicates need for reduction +/- fixation

Metacarpal Base Fracture Xray / Diagnostic Tests

  • P/A and lateral views of hand
  • 30-45 degree suppinated or pronated views
  • metacarpal base fractures are easily missed due to poor xrays.

Metacarpal Base Fracture Classification / Treatment

  • Undisplaced: buddy-taping
  • Displaced Extra-articular:(angulation >30 degrees, shortening >4mm, any rotational deformity) =CRPP vs ORIF. Long oblique fractures may be treated with parallel miniture screw fixation (Freeland, Orthopaedics 17:199;1994). Tranverse fractures may be treated with intrameduallary nails (Gonzalez MH, CORR 1996;327:47) or ORIF with mini-plates. (Bosscha K, Injury, 1993;24:166). Open fracture: consider mini-external fixation. (Freeeland AE, CORR, 1987;214:93)
  • Displaced Articular: CRPP vs ORIF with k-wires or mini-lag screws.

Metacarpal Base Fracture Associated Injuries / Differential Diagnosis

  • fracture of adjacent metacarpal
  • fight bite

Metacarpal Base Fracture Complications

  • Malunion
  • Nonunion
  • stiffness
  • hardware failure
  • complex regional pain syndrome
  • infection

Metacarpal Base Fracture Follow-up Care

Metacarpal Base Fracture Review References

  • Freeland AE, Geissler WB, Weiss AP, Operative Treatment of Common Displaced and Unstable Fractures of the Hand, JBJS 2001;83A:928-945
  • Freeland AE, Orbay JL. ORIF of the Tubular Bones of the Hand In: Stickland JW, Grahma TJ, editor. Hand 2nd ed. Master Techniques in orthopedic surgery. Philadeplhia: Lippincott-Raven; 2004. p 3