CLINICAL UPDATE
Fifth metacarpal neck fracture
Fifth MC neck fracture (‘ boxer ’ s fracture ’) is usually caused by punching a solid surface , and is most common in young males aged 10-29 . This fracture accounts for 20 % of hand fractures – as well as local bruising , oedema and pain , the 5th metacarpal head may be less pronounced ( volar angulation ).
Angulation critical While a patient presenting with < 300 volar angulation can usually be managed non-surgically with satisfactory functional outcome , there should be no rotational deformity .
In 5 % of cases , significant rotational deformity ( i . e . > 100 ) shows in finger flexion , as the small digit crosses the palm or points toward the ulnar side of the hand ( Fig 1 ). An x-ray confirms the diagnosis ( Fig 2 ).
Management Treatment goals are : �� ���������������������������������������������� �� ����������������������������������������� �� ��������������������������������������� �� ���������������������
Splinting with a hand-based ulnar gutter design immobilises the metacarpals of the 4th as well as the 5th digits in 300 flexion . The wrist , inter-phalangeal ( IP ) joints and uninvolved digits are kept moving ( Fig 3 ).
A buddy strap or sleeve allows the patient to perform assisted exercises at the IP joints , reducing the risk of rotational deformity .
Activities are limited to prevent further injury ( e . g . tight grasping and impact activities , such as
��Fig . 2
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By Ms Alex Retallick , Occupational Therapist / Certified Hand Therapist .
Tel 0414 305 435 . hammering ) while light functional tasks continue with the splint and buddy strap on .
Graded exercises of the MCP joint lead to resistive exercises as healing occurs , with splint use until there is satisfactory healing ( up ��Fig . 1 to 6 weeks post fracture ). Return to impact activities such as hammering , rattle guns and jack-hammering is usually safe after 12 weeks .
Coinciding crushing of surrounding soft tissue risks adhesion and stiffness , and in a small number of cases , a rupture ��Fig . 3 of the extensor digit minimus tendon shows as inability to actively extend the PIP joint . �
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