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Hand Metacarpal and Phalangeal Fractures: Causes, Symptoms, and Management

Learn about metacarpal and phalangeal fractures, including their causes, symptoms, and various management techniques such as RICE and splinting. Understand the types of fractures and their corresponding treatments.

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Hand Metacarpal and Phalangeal Fractures: Causes, Symptoms, and Management

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  1. Metacarpals • Palpated in order • Numbered 1 -5 • Starting at thumb • Palpate the entire length 1st Metacarpal Trapezium 1st Metacarpal • From Snuffbox to MCP Joint • Shorter and broader than other metacarpals

  2. Metacarpal Fracture • Etiology • Direct axial force or • Compressive force • 5th metatarsal • Boxing or martial arts • (boxer’s fracture) • Signs and Symptoms • Pain • Swelling • Crepitus • Possible deformity • angular • rotational • Fracture tests • Palpation • Compression • Axial compression • Percussion • Management • RICE • Analgesics • X-ray examination • Deformity is reduced • Splinting • 30 degrees of flexion • 4 weeks

  3. Phalangeal Fractures Proximal Fracture Middle Fracture • Etiology • Direct trauma • Twist • Signs and Symptoms • Pain • Swelling • Deformity • Crepitus • Management • RICE • Proximal Fracture • Splint • Buddy taping • Middle Fracture • No deformity • Buddy tape w/ thermoplastic splint for activity • Deformity • Immobilization for 3-4 weeks • Protective splint for an additional 9-10 weeks during activity

  4. Distal Phalangeal Fracture • Etiology • Crushing force • Signs and Symptoms • Pain • Swelling • Crepitus • Subungual hematoma • Management • RICE • Protective splint • 0º flexion

  5. Joints • Metacarpophalangeal Joint • Proximal Interphalangeal Joint • (PIP Jt.) • Distal Interphalangeal Joint • (DIP Jt.) • Interphalangeal Joint • Thumb (IP)

  6. IP Joint Anatomy Middle Phalange Collateral Ligament Accessory Ligament Volar Plate Checkrein Ligament Accessory Ligament Collateral Ligament Distal Middle Phalange Proximal Phalange Proximal Volar Plate

  7. IP Joint Sprains • Special Tests • Fracture tests • Radial and Ulnar deviation • Assess collateral ligaments • Anterior and posterior glide tests • Assess joint capsule • Etiology • Fingers are prone to sprains • Direct blows or twisting • Occurs w/ axial loading or • Valgus/varus stresses • Similar to fractures and dislocations • Injury can damage • Collateral ligaments • Volar plate

  8. Interphalangeal Joint Sprains • Management • RICE • X-ray examination • PIP sprain • 30 - 40º flexion • 10 days • DIP Sprain • Splint for a few days • Full extension • Taping Collateral Ligament Volar Plate

  9. Metacarpophalangeal Joints (MC-P Joints) Head of 2nd Metarsal • Assessment • Place joint in full flexion • Radial deviation • Ulnar deviation • Rotation • Palpation • Place joint in flexion • Joint exposed better • Groove for extensor tendon

  10. PIP and DIP Dislocations • Etiology • Hyperextension Dorsal PIP • Axial load on a partially flexed DIP joint • Management • RICE • Reduction by MD • Post reduction splinting • Buddy taping • Begin motion at 3 weeks • Large bone fragments splint 30-60º flexion • Small bone fragments buddy taping • Signs and Symptoms • Obvious deformity • Swelling • Possible avulsion volar plate • Possible fracture

  11. Mallet Finger (baseball or basketball finger) Jersey Finger • Etiology • Caused by a blow that contacts tip of finger • Etiology • DIP joint injury • Rupture of flexor muscle • Common injury to football lineman

  12. Subungual Hematoma • Bruising bleeding under fingernail • Extremely painful due to build-up of pressure under nail • Pressure must be released once hemorrhaging has ceased • Release as distally as possible • Bandage with antibiotic ointment • Hot paper clip • Finger nail drill • Scalpel

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