Learning objectives: After reading this article, the participant should be able to: 1. Identify the fracture patterns and types of metacarpal fractures. 2. Recognize when surgery is indicated for a given fracture. 3. Discuss the pathophysiology of Bennett's fractures and treatment. 4. List surgical treatment options and their relative advantages and disadvantages. 5. Be familiar with pediatric metacarpal injuries and when surgery is indicated.
Background: Metacarpal fractures are among the most common injuries seen in the emergency room and a staple for the hand surgeon. Knowledge of the types of fractures that occur and the appropriate treatment options is critical core knowledge for the hand surgeon. With the advent of superior implants and intraoperative fluoroscopy, powerful treatment options exist for metacarpal fractures and are at the disposal of the informed hand surgeon.
Methods: Closed reduction and cast immobilization, Kirschner wires, lag screws, plate fixation, and other techniques are all available to the hand surgeon. Bone grafting in highly comminuted fractures also deserves consideration.
Results: The majority of metacarpal fractures can be treated closed and do well with compliant hand therapy. Those fractures requiring operative intervention likewise do well, provided that the appropriate technique is used for the situation. For example, long oblique shaft fractures are optimally treated with lag screws, whereas short oblique fractures do better with Kirschner wires or plate fixation. When the correct therapy is tailored to the injury, most metacarpal fractures can be treated with predictably good outcomes.
Conclusions: Metacarpal fractures are common occurrences in the office of the hand surgeon. The different types of injury patterns must be recognized by the surgeon and appropriate treatment then executed to serve both the patient and hand surgeon optimally.