* Localize fracture to head, neck or shaft (neck most common)
5th metacarpal most commonly fractured
* Note amount of angulation, shortening and the presence of malrotation
*Treatment is based on which metacarpal is fractured and the location of the fracture
*The amount of acceptable angulation varies by the digit involved
For example for index and long finger - acceptable angulation of the shaft is 10-20 degrees and neck is 10 to 15 degrees
Whereas for the 5th digit - acceptable angulation for the shaft is 40 degrees and neck is 50 degrees
Pearls
No degree of malrotation is acceptable (document the absence of this!)
Strongly suspect fight bite injury with abrasions/lacerations overlying metacarpal heads
Highly prone to infection given the proximity to the joint capsule
Consider lacerations over metacarpal fractures as open fractures (do not close/discuss management with hand surgery re timing of washout. Many prefer delayed fixation for suspected infections )
Document integrity of the extensor tendon (can be lacerated and retracted)
