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. �
Competing interests: the author provides hand rehabilitation services
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