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Fracture of metacarpal bones: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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Fractures of metacarpal bone account for 2.5% of all bone lesions in the skeleton.
It should be noted that the mechanism of injury, the nature of the fracture and the type of displacement of injuries of the first metacarpal bone differ from the fractures of II-V metacarpal bones, so there is a need to consider these nosological forms separately.
ICD-10 code
S62.3. Fracture of other metacarpal bone.
What causes fracture of metacarpal bones?
They arise mainly as a result of a direct mechanism of injury (blow on the brush or blow with a brush on a solid object), but can also occur with an indirect application of force (axial load, flexion, twisting).
Symptoms of fracture of metacarpal bones
Patients complain of pain in the place of injury, limb function limitation.
Diagnosis of fracture of metacarpal bones
Anamnesis
In the history - indication of an injury.
Examination and physical examination
When examined, a significant edema of the rear of the hand is determined, a cyanotic coloration due to a bruise. When the hand is clenched into a fist, the convexity of the head of the metacarpal bone disappears with the fracture of its body. Palpation of the broken bone is painful, sometimes displaced fragments (in the form of a step) are probed. A positive symptom of the axial load - pressing on the head of the metacarpal bone or on the main phalanx of the finger along the long axis causes pain in the place of the alleged fracture. Movement in the joints of the hand is limited, the grasping function is sharply violated.
Laboratory and instrumental research
Confirm the diagnosis by radiographing the brush in two planes.
For fractures of metacarpal bones, typical displacement of fragments with an angle open in the palmar side is typical. There is a deformation due to the reduction of interstitial and vermiform muscles. Significant displacements along the length and width, as a rule, do not happen, since the metacarpal bones in the proximal and distal sections are fastened with ligaments. However, with an oblique or spiral fracture line, displacement occurs almost always, in some cases it is impossible to retain fragments after comparison. As a result of direct trauma, multiple as well as complex multi-lobe fractures are possible, up to the crushing of the hand.
[Treating fracture of metacarpal bones
Indications for hospitalization
On an outpatient basis and under the supervision of a family doctor, patients with closed fractures of metacarpal bones are treated without fracture displacement, with transverse fractures of one or more bones, with angular deformations.
10-15 ml of 1% solution of procaine is injected into the fracture site. After waiting 5-10 minutes, they produce a manual reposition. The assistant performs traction by the fingers of the hand. The surgeon presses on the back surface at the site of the fracture, moving the fragments to the palm side, and simultaneously presses the head of the fractured metacarpal bone, trying to shift it to the rear. Such actions eliminate the displacement of fragments at an angle. The limb is fixed with a dorsal gypsum longus from the upper third of the forearm to the heads of metacarpal bones with the capture of the finger, which joins the broken bone (for 4 weeks).
X-ray images are taken after repositioning and at the end of the fixation period. If a fracture has grown together, they begin to develop movements in previously immobilized joints. The ability to work is restored in 5-6 weeks.
In all cases of complex injuries of the pastern (multiple fractures of II-IV metacarpal bones, as well as fractures with displacement) or when the success of treatment in a polyclinic is doubtful (unstable fractures), patients should be referred for inpatient treatment. In the hospital it is possible to apply methods of skeletal traction, compression-distraction osteosynthesis, various methods of surgical interventions.
Conservative treatment of fracture of metacarpal bones
Treatment of fractures of metacarpal bones can be conservative and operative. With conservative treatment, a closed manual reposition is made after anesthesia of fracture sites with a 1% solution of procaine, 5-7 ml at each point. The assistant performs traction by the fingers of the hand. The surgeon presses on the back surface at the site of the fracture, moving the fragments to the palm, and simultaneously presses the heads of broken metacarpals, trying to shift them to the rear. The extremity is fixed with a back gypsum lanceum from the upper third of the forearm to the fingertips. The term of permanent immobilization with single fractures is 4 weeks, for multiple fractures 4-5 weeks, then within 2-3 weeks the limb is fixed with a removable longus.
In oblique and spiral fractures, when a secondary displacement of fragments easily occurs, skeletal traction is used for the terminal phalanges.
Surgical treatment of fracture of metacarpal bones
Operative treatment consists in open reposition and fixation of fragments. Apply a plaster longure for 4 weeks.