METACARPAL FRACTURE OF THE LITTLE FINGER

METACARPAL FRACTURE OF THE LITTLE
FINGER (BOXER’S FRACTURE)
When a boxer punches the jaw of his opponent with
his fist and wins the bout, his ecstasy may be shortlived
when he finds his little finger is broken, what
he has actually broken is the neck of the fifth
metacarpal bone and this is due to a direct impact
on the dorsum of the hand.
Mechanism of Injury
This injury is also seen in assaults, RTAs, fall, etc.
Clinical Features
Patient may present with pain, swelling, tenderness
over the dorsum of the ulnar border of the hand.
Radiographs
Plain X-ray of the hand AP, lateral and oblique views
helps to make the diagnosis.
Treatment
These fractures need to be accurately reduced with
no rotational malalignment. Closed reduction and
fixation with either plaster cast or percutaneous
K-wire fixation can do this.
METACARPAL HEAD FRACTURES
These are also known as ‘fight bite’ fractures as they
occur when the patient strikes an opponent’s teeth
in a fist fight. The clinical presentation and the
investigations are the same as for metacarpal neck
fractures. They are frequently intra-articular and
Figs 16.22A to C: Metacarpal fractures treated by closed
reduction and percutaneous pinning: (A) Unstable fracture
fixed with criss-cross K-wires, (B) Neck fracture fixed by
intramedullary fixation, (C) Bennett’s fracture fixed with Kwire
need open reduction and internal fixation with Kwire.
METACARPAL FRACTURE OF THE THUMB
Salient Features
• Most of the thumb metacarpal fractures are intraarticular
at the carpometacarpal joint.
• The volar beak of basal fracture is not palpable.
• Special X-ray views consisting of true AP and
lateral views are required.
• Basal fractures of the thumb are divided into:
– Extra-articular fractures: Transverse/oblique.
– Partial articular fracture (Bennett’s).
– Total articular fracture (Rolando’s).
These fractures have been dealt in the previous
chapter.