top of page

Ortho Hors D'oeuvres (Answer):

  • Josie Valenzuela
  • Jul 23, 2015
  • 2 min read

To review, this is a 23 year-old male presenting with hand pain after punching a wall.

Questions and Answers:

1) What is the key finding on x-ray? What is its eponym?

There is a fracture of the distal aspect (the neck) of the 5th metacarpal. This fracture does not involve the joint or the midshaft of the metacarpal. This fracture is known as a boxer’s fracture.

2) What are important physical exam findings?

As in every fracture, wounds suggesting open fracture must be identified; wounds over the MCP joint with this fracture likely indicate open fracture and require immediate operative washout and repair, with IV antibiotics within the first hour. For fractures that are closed, malrotation must be assessed for. Assess malrotation (scissoring) by flexing fingers in their normal cascade.

Finally, dorsal wounds can affect the dorsal sensory branch of the radial/ulnar nerves and volar wounds can involve digital nerves, so normal two-point discrimination and distal motor function should be evaluated.

3) What are the next steps in management?

Default management should be ulnar gutter placement with the wrist in 20 degrees of extension and the metacarpophalangeal joint flexed at 90 degrees.However, treatment can range from buddy taping to ulnar gutter placement to operative management depending on fracture angulation and an orthopedic follow-up should be arranged within the next week to discuss possible operative fixation or buddy taping. Below is the general acceptable degree of head angulation for each metacarpal (note more angulation is tolerated moving from index to little finger).

References:

Haughton DN, Jordan D, and Khan W. "Principles of Hand Fracture Management." Open Orthopedics Journal 6 (2012): 43-53.

Davenport M, Sotereanos D. “Injuries to the Hand and Digits” In: Tintinalli JE et al. Tintinalli Emergency Medicine 6th ed. New York: McGraw-Hill;2—4:1709-1730.

Thanks to Eric Silman for the plain film!

 
 
 

Comments


Featured Posts
Recent Posts
Search By Tags

Important: If you think you have a medical emergency, call 911 or go to the nearest hospital. The views expressed on this site are my own. Do not attempt emergency care through this site. The intended audience for this site is other emergency medicine physicians in an educational setting, and the information contained on this website provides general information for educational purposes only; it is not a substitute for medical or professional care. This site is not designed to and does not provide medical advice, professional diagnosis, opinion, treatment or services to you or to any other individual, and you should not use the information in place of a visit, call consultation or the advice of your physician or other healthcare provider. I am not liable or responsible for any advice, course of treatment, diagnosis or any other information, services or product you obtain through this site. The views expressed on this site should not be considered complete or exhaustive, nor should you exclusively rely on such information to recommend a course of treatment for you or any other individual.

bottom of page