Metacarpal Fractures

Welcome to Temple University's Evidence-Based Practice project. This project was created by and for the students at Temple University in Philidelphia, and is part of the Orthopaedic curriculum. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Let me know if you need any assistance.Be the first to edit this page and have your name permanently included as the original editor, see the editing pages tutorial for help.

Original Editor - Your name will be added here if you created the original content for this page. Lead Editors - Your name will be added here if you are a lead editor on this page.  Read more.

Clinically Relevant Anatomy

The five metacarpal bones form the skeleton of the palm of the hand between the carpal bones and the phalanges. Each are comprised of a base, shaft, and head. The proximal bases of the metacarpals articulate with the carpal bones, and the distal heads of the metacarpals articulate with the proximal phalanges and form the knuckles. The 1st metacarpal (of the thumb) is the thickest and shortest of these bones. The 3rd metacarpal is distinguished by a styloid process on the lateral side of its base. Soft tissues generally involved with fractures include cartilage, joint capsule, ligaments, fascia, and the dorsal hood fibers. With severe polytrauma cases, the tendons and nerves adjacent to the fracture can also be injured¹.

Mechanism of Injury / Pathological Process

Metacarpal Base Fractures: These fractures are intra-articular and result from high forces (violent accidents), direct blows, or crushing injuries that disrupt the rigid carpal ligaments, or overwhelm the normal flexibility of the ulnar metacarpals. They also occur with an avulsion of the wrist flexors or extensors, that insert on the metacarpal base, resulting from a direct blow or torsional injury. The most common occurrence is at the 5th metacarpal-hamate articulation. The healing rate varies from three to six weeks¹.

Clinical Presentation

Metacarpal Shaft Fractures: These fractures are extra-articular and are caused by longitudinal compression, torsion, or direct impact that may result from a fall, blow, or crushing force that usually angulates dorsally. They are described by the fracture configuration as transverse, oblique, spiral, or comminuted. Metacarpal shaft fractures are slower to heal than the more distal or proximal locations because of the predominantly cortical bone found there. The healing rate varies from three to seven weeks¹.

Diagnostic Procedures

add text here relating to diagnostic tests for the condition

Outcome Measures

add links to outcome measures here (see Outcome Measures Database)

Management / Interventions

add text here relating to management approaches to the condition

Differential Diagnosis

add text here relating to the differential diagnosis of this condition

Key Evidence

add text here relating to key evidence with regards to any of the above headings

Resources

add appropriate resources here

Case Studies

add links to case studies here (case studies should be added on new pages using the case study template)

References

References will automatically be added here, see adding references tutorial.