From the Guidelines
The most common metacarpal fracture is the fifth metacarpal neck fracture, also known as a boxer's fracture, which typically occurs when a person strikes an object with a closed fist, causing the metacarpal neck to break and often resulting in volar angulation of the metacarpal head. This injury is a common presentation in emergency departments and hand clinics, and its diagnosis is often facilitated by radiographic examination, as recommended by the American College of Radiology 1. The standard 3-view radiographic examination of the hand is usually sufficient to detect most fractures and dislocations of the metacarpals and phalanges, including the fifth metacarpal neck fracture 1.
Some key points to consider in the management of metacarpal fractures include:
- The degree of angulation, with conservative management being appropriate for uncomplicated fifth metacarpal fractures with less than 30-40 degrees of angulation and less than 3-4mm of shortening
- The presence of rotational deformity or intra-articular involvement, which may require surgical intervention with K-wire fixation or open reduction internal fixation
- The importance of proper assessment, including checking for rotational alignment by having the patient flex their fingers, as malrotation can significantly impact hand function and should prompt surgical referral.
It is essential to note that these fractures are more common in young adult males and are often associated with aggressive behavior or sports injuries, highlighting the need for careful evaluation and management to optimize outcomes and minimize morbidity.
From the Research
Most Common Metacarpal Fractures
- The most common metacarpal fractures involve the neck of the fifth metacarpal, known as the boxer fracture 2, 3, 4.
- Fractures of the metacarpal, particularly the 5th metacarpal, are quite common among all hand fractures and have a high incidence in the male adult population 5.
- The fifth metacarpal neck fracture, resulting from direct trauma to the clenched fist, is the most typical presentation to emergency departments worldwide 3.
Characteristics of Metacarpal Fractures
- Metacarpal fractures account for 30% to 40% of all hand fractures and usually occur in adolescents and young adults 2.
- The mechanism of injury is often direct trauma, but can also occur with an axial load or torsional loading (twisting) 2.
- Fractures of the metacarpals are subdivided into the metacarpal head, neck, shaft, and base 2.
Management of Metacarpal Fractures
- Conservative management is the preferred option for closed, non-angulated, non-malrotated fractures, while open fractures, significant angulation, rotational deformity, and intra-articular extension are recognized indications for surgical intervention 5, 3, 6.
- The acceptable angulation for conservative management for most studies is 70 degrees 5.
- Buddy strapping with a Futura splint provides good functional results for non-operative management 5.