UMEM Educational Pearls

Category: Orthopedics

Title: Fifth Metacarpal Fracture

Keywords: Boxer, reduction (PubMed Search)

Posted: 5/28/2022 by Brian Corwell, MD (Updated: 6/25/2022)
Click here to contact Brian Corwell, MD

28-year-old male present with dorsal hand pain after “losing his temper”

On exam, you note dorsal swelling, tenderness, and deformity

AP, lateral and oblique views are obtained.

https://images.squarespace-cdn.com/content/v1/55d5e97fe4b0c4913b06a4dd/1440082762211-V6RW1TTWB1Q5C89TPIEC/boxers+2.jpg?format=500w

There is no rotational deformity but using the lateral view, you note that there is angulation

Measured as the shaft of the metacarpal as compared to the mid-point of the fracture fragment

Acceptable shaft angulation generally accepted to be less than 40°

Patient has greater that acceptable angulation so you have to perform closed reduction

After appropriate pain control consider the “90-90 method.” 

Flex the MCP, DIP, and PIP joints to 90 degrees.

This positioning stretches the MCP collateral ligaments helping to optimize reduction

Next, apply volar pressure over the dorsal aspect of the fracture site while applying pressure axially to the flexed PIP joint.

Best demonstrated below

https://www.youtube.com/watch?v=40irKoUJqsM