MANUAL MINORS
Fractures of the metacarpal bones of the index, middle, and ring fingers are common injuries, especially in situations of direct trauma, such as blows or falls, or from twisting mechanisms. These fractures can affect the alignment of the hand, impairing the function and mobility of the affected fingers.
Diagnosis
Diagnosis is based on clinical evaluation, which may reveal pain, swelling, visible deformity, and difficulty moving the affected fingers. X-rays confirm the presence and type of fracture, such as transverse, oblique, spiral, or comminuted fractures. Radiological evaluation also helps assess any displacement or rotation of the fractured bone.
Differential Diagnosis
Condition | Main Characteristics |
|---|---|
Metacarpophalangeal dislocation | Joint displacement without visible fracture on X-rays. |
Proximal phalanx fracture | Injury to the proximal phalanx rather than the metacarpal, with distinct radiological findings. |
Severe contusion | Trauma without bone fracture but with pain, swelling, and limited movement. |
Emergency Management
In the emergency setting, initial management includes immobilising the finger and hand with a volar splint or splint in a functional position to reduce movement and alleviate pain. Analgesics and anti-inflammatory medications are given as needed. For displaced or unstable fractures, closed reduction under local anaesthesia may be performed, followed by immobilisation.
Definitive Treatment
Non-displaced fractures: Managed with immobilisation in a splint for 3 to 6 weeks.
Displaced, unstable, or rotational fractures: Require open reduction and internal fixation (ORIF) using pins, screws, or plates to restore alignment.
Postoperative physiotherapy is essential to regain mobility and prevent stiffness in the hand and fingers.
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