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Metacarpal Fracture and Dislocation
Carol L. Andrews, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Definitions

            • Dislocation: Complete dissociation of articular surfaces
            • Subluxation: Partial dissociation of articular surfaces
            • Fracture types
              • Boxer fracture: 4th or 5th metacarpal (MC) neck fracture; MC head volar angulation
                • Also termed brawler's fracture since boxer is not likely to get this injury
              • Epibasal fracture: Stable 2-part transverse fracture of proximal 1st MC
              • Bennett fracture: Oblique intraarticular fracture of 1st MC base, resulting in small triangular volar lip fragment
              • Rolando fracture: Intraarticular comminuted 1st MC base fracture
                • Often forms Y- or T-shaped configuration
              • "Fight bite": Opponent's tooth breaks skin over MCP joint with injury to dorsal capsule, extensor tendon, ± MC head

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • Mechanisms of Injury

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Consider

                                  • Reporting Tips

                                    Selected References

                                    1. Cotterell IH et al: Metacarpal and phalangeal fractures in athletes. Clin Sports Med. 34(1):69-98, 2015
                                    2. Gehrmann SV et al: Fracture-dislocations of the carpometacarpal joints of the ring and little finger. J Hand Surg Eur Vol. 40(1):84-7, 2015
                                    3. Cano Gala C et al: Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: a case report and review of literature of the last 20 years. Int J Surg Case Rep. 4(5):442-5, 2013
                                    4. Sletten IN et al: Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter- and intra-observer validity and reliability study. J Hand Surg Eur Vol. 38(6):658-66, 2013
                                    5. Fufa DT et al: Fractures of the thumb and finger metacarpals in athletes. Hand Clin. 28(3):379-88, x, 2012
                                    6. Lisle DA et al: MR imaging of traumatic and overuse injuries of the wrist and hand in athletes. Magn Reson Imaging Clin N Am. 17(4):639-54, vi, 2009
                                    7. Wessely K et al: Ultrasound findings of the locked metacarpophalangeal joint. Skeletal Radiol. 38(1):85-9, 2009
                                    8. Al-Qattan MM: The triad of multiple metacarpal fractures and/or dislocations of the fingers, severe hand swelling and clinical evidence of acute median nerve dysfunction. J Hand Surg Eur Vol. 33(3):298-304, 2008
                                    9. Leggit JC et al: Acute finger injuries: part II. Fractures, dislocations, and thumb injuries. Am Fam Physician. 73(5):827-34, 2006
                                    10. Dillon J et al: Divergent dislocation of the ring and little finger carpometacarpal joints--a rare injury pattern. Acta Orthop Belg. 71(3):353-6, 2005
                                    11. Daniels JM 2nd et al: Hand and wrist injuries: Part II. Emergent evaluation. Am Fam Physician. 69(8):1949-56, 2004
                                    12. Rettig AC: Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 32(1):262-73, 2004
                                    13. Rosner JL et al: Imaging of athletic wrist and hand injuries. Semin Musculoskelet Radiol. 8(1):57-79, 2004
                                    14. Lawlis JF 3rd et al: Carpometacarpal dislocations. Long-term follow-up. J Bone Joint Surg Am. 73(1):52-9, 1991
                                    Related Anatomy
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                                    Related Differential Diagnoses
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                                    References
                                    Tables

                                    Tables

                                    KEY FACTS

                                    • Terminology

                                      • Imaging

                                        • Clinical Issues

                                          • Diagnostic Checklist

                                            TERMINOLOGY

                                            • Definitions

                                              • Dislocation: Complete dissociation of articular surfaces
                                              • Subluxation: Partial dissociation of articular surfaces
                                              • Fracture types
                                                • Boxer fracture: 4th or 5th metacarpal (MC) neck fracture; MC head volar angulation
                                                  • Also termed brawler's fracture since boxer is not likely to get this injury
                                                • Epibasal fracture: Stable 2-part transverse fracture of proximal 1st MC
                                                • Bennett fracture: Oblique intraarticular fracture of 1st MC base, resulting in small triangular volar lip fragment
                                                • Rolando fracture: Intraarticular comminuted 1st MC base fracture
                                                  • Often forms Y- or T-shaped configuration
                                                • "Fight bite": Opponent's tooth breaks skin over MCP joint with injury to dorsal capsule, extensor tendon, ± MC head

                                            IMAGING

                                            • General Features

                                              • Radiographic Findings

                                                • CT Findings

                                                  • MR Findings

                                                    • Imaging Recommendations

                                                      DIFFERENTIAL DIAGNOSIS

                                                        PATHOLOGY

                                                        • Mechanisms of Injury

                                                          CLINICAL ISSUES

                                                          • Presentation

                                                            • Demographics

                                                              • Natural History & Prognosis

                                                                • Treatment

                                                                  DIAGNOSTIC CHECKLIST

                                                                  • Consider

                                                                    • Reporting Tips

                                                                      Selected References

                                                                      1. Cotterell IH et al: Metacarpal and phalangeal fractures in athletes. Clin Sports Med. 34(1):69-98, 2015
                                                                      2. Gehrmann SV et al: Fracture-dislocations of the carpometacarpal joints of the ring and little finger. J Hand Surg Eur Vol. 40(1):84-7, 2015
                                                                      3. Cano Gala C et al: Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: a case report and review of literature of the last 20 years. Int J Surg Case Rep. 4(5):442-5, 2013
                                                                      4. Sletten IN et al: Assessment of volar angulation and shortening in 5th metacarpal neck fractures: an inter- and intra-observer validity and reliability study. J Hand Surg Eur Vol. 38(6):658-66, 2013
                                                                      5. Fufa DT et al: Fractures of the thumb and finger metacarpals in athletes. Hand Clin. 28(3):379-88, x, 2012
                                                                      6. Lisle DA et al: MR imaging of traumatic and overuse injuries of the wrist and hand in athletes. Magn Reson Imaging Clin N Am. 17(4):639-54, vi, 2009
                                                                      7. Wessely K et al: Ultrasound findings of the locked metacarpophalangeal joint. Skeletal Radiol. 38(1):85-9, 2009
                                                                      8. Al-Qattan MM: The triad of multiple metacarpal fractures and/or dislocations of the fingers, severe hand swelling and clinical evidence of acute median nerve dysfunction. J Hand Surg Eur Vol. 33(3):298-304, 2008
                                                                      9. Leggit JC et al: Acute finger injuries: part II. Fractures, dislocations, and thumb injuries. Am Fam Physician. 73(5):827-34, 2006
                                                                      10. Dillon J et al: Divergent dislocation of the ring and little finger carpometacarpal joints--a rare injury pattern. Acta Orthop Belg. 71(3):353-6, 2005
                                                                      11. Daniels JM 2nd et al: Hand and wrist injuries: Part II. Emergent evaluation. Am Fam Physician. 69(8):1949-56, 2004
                                                                      12. Rettig AC: Athletic injuries of the wrist and hand: part II: overuse injuries of the wrist and traumatic injuries to the hand. Am J Sports Med. 32(1):262-73, 2004
                                                                      13. Rosner JL et al: Imaging of athletic wrist and hand injuries. Semin Musculoskelet Radiol. 8(1):57-79, 2004
                                                                      14. Lawlis JF 3rd et al: Carpometacarpal dislocations. Long-term follow-up. J Bone Joint Surg Am. 73(1):52-9, 1991