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Fracture of the first metacarpal bone: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Particular attention is paid to this bone due to the fact that the first metacarpal bone is located separately from the others, is very mobile, participates in bringing, leading and contrasting the first finger. It is also functionally equivalent to the other four fingers.
ICD-10 code
S62.2. Fracture of first metacarpal bone.
Bennett fracture
Causes
Bennett fracture occurs as a result of a stroke directed along the axis I of the finger. At the same time, a dislocation occurs in the carpally-metacarpal joint with a simultaneous fracture of the base of the first metacarpal bone, which, shifting upward, breaks off the triangular fragment of the ulnar margin of its base. Thus, the fracture of Bennett is more correctly called fracture of the first metacarpal bone.
Symptoms and Diagnosis
Complaints of pain in the place of fracture, restriction of brush functions. The radial side of the wrist joint is deformed due to the standing I metacarpal bone and edema. The contours of the "anatomical snuffbox" are smoothed. Palpation of the first carpometacarpal joint and axial load on the first finger are painful. Sharply limited is the reduction, withdrawal and opposition of the first finger. The radiograph confirms the diagnosis.
Treatment
Conservative treatment. In the area of the first carpometacarpal joint, 5-10 ml of a 2% solution of procaine is administered. After the onset of anesthesia, the first metacarpal bone is corrected. This is achieved by traction along the axis and by the retraction of the 1st finger. The limb is fixed with a circular plaster bandage from the upper third of the forearm to the metacarpophalangeal joints with the capture of the main phalanx I of the finger in the abduction position. A control radiograph is necessary. If repositioning and reposition have come, immobilization is left for 4-6 weeks.
Surgery. If the referrals did not work out, you should try again or send the patient to the hospital, where skeletal traction or surgical methods of treatment are possible.
In case of unsuccessful attempts of correction, skeletal traction or fixation with a Kirschner knitting needle using an autoship is applied.
Estimated period of incapacity for work. Workability is restored in 6-8 weeks.
[Flexural fracture of the first metacarpal bone
Causes
The flexural fracture of the first metacarpal bone occurs when the forcible bending of the first metacarpal bone is ramped to the palmar-elbow side (when striking against a hard object). In this case, unlike the Bennett fracture, the fracture line passes beyond the joint, distal to it by 1-1.5 cm. The fragments are displaced at an angle open in the palmar side.
Often, these fractures occur during fights and beginners who incorrectly perform side strikes.
Symptoms and Diagnosis
Symptoms and diagnosis are identical to Bennett's fracture, except that palpation is determined by undeformed carpometacarpal joint. The difference is detected and radiological.
Treatment
The treatment is conservative. Under local anesthesia, a manual reposition is performed with the removal of angular deformity and fixed in the same way as in the case of a Bennett fracture. The period of immobilization with a fracture of the base and the body of the first metacarpal bone is 4-5 weeks. In cases where reposition has not been successful, skeletal traction or a surgical method of treatment is used.
Estimated period of incapacity for work. Recovery of disability occurs in 6-7 weeks.