MANUAL MINORS
Fifth metacarpal fractures, commonly known as “boxer’s fractures,” are frequent injuries affecting the bone that connects the pinky finger to the wrist. These fractures typically result from direct blows with a closed fist, such as in contact sports or fights, and primarily affect the neck of the metacarpal.
Diagnosis
Diagnosis is based on the history of trauma, along with clinical signs such as localised pain, swelling, bruising, and deformity in the affected area. The little finger may be displaced towards the palm (volar angulation). X-rays confirm the fracture and allow for evaluation of displacement or angulation of the bone.
Differential Diagnosis
Condition | Main Characteristics |
|---|---|
Carpometacarpal dislocation | Displacement of the joint between the carpus and metacarpal, without visible bone fracture. |
Fourth metacarpal fracture | Fracture in the neighbouring bone, with similar symptoms and treatment. |
Metacarpophalangeal sprain | Ligament injury without bone fracture, causing pain and swelling but no bone deformity. |
Emergency Management
In the emergency setting, initial management includes immobilisation with a functional position splint (slight wrist extension and finger flexion) to reduce pain and stabilise the fracture. Analgesics and anti-inflammatory medications are administered as needed. In cases of significant displacement or angulation, a closed reduction under local anaesthesia may be performed.
Definitive Treatment
Non-displaced or mildly angulated fractures (<30-40 degrees): Managed with immobilisation in a splint for 3-4 weeks.
Significant angulation or displacement: If closed reduction is ineffective, open reduction and internal fixation (ORIF) using pins or plates is recommended to correct the alignment.
Post-immobilisation physiotherapy is essential to restore normal function of the pinky finger and prevent stiffness.
Opmerkingen