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Metacarpal Fractures are the most common hand injury and are divided into fractures of the head, neck, or shaft. Diagnosis is made by orthogonal radiographs the hand. Treatment is based on which metacarpal is involved, location of the fracture, and the rotation/angulation of the injury.
Fractures of the base of the metacarpal bones may be the result of direct or indirect trauma. This topic will review the presentation, diagnosis, and nonoperative management of fractures of the base of the metacarpal bones (not including the thumb).
Each digit has a metacarpal bone, with the 1st metacarpal supporting the thumb and the 5th metacarpal assisting the little finger. Each metacarpal has a head, shaft, neck, and base. The heads articulate with the proximal phalanges distally, while the bases articulate with the carpus proximally.
Fracturing the neck of the metacarpal that connects to your pinkie finger (your fifth metacarpal) is sometimes referred to as a boxer’s fracture. It’s the most common metacarpal fracture, making up 1 in every 4 metacarpal fractures.
The base of fifth metacarpal bone is the expanded, proximal end of the bone. It is the proximal continuation of its body and contains the: —proximal articular facet of fifth metacarpal bone; —capitate articular facet of fifth metacarpal bone; —fourth metacarpal articular facet of fifth metacarpal bone.
Figure 2: Fracture of the base of the 5th metacarpal. Soft tissue swelling, denoted by the arrow, is perhaps a more obvious finding than the fracture itself. To the right, a close-up view of the base of the metacarpal shows the fracture line, outlined in red in the image below.
The metacarpal bone 5 is the smallest of all five metacarpals. Its base slightly differs from the other metacarpals, as its lateral part is non-articular and instead features a tubercle for the attachment of the extensor carpi ulnaris muscle. The lateral side of the base, however, articulates with the hamate bone.