Fracture of the metacarpal neck
A blow may fracture the metacarpal neck , usually of the fifth finger the (BOXER`S) fracture . There may be local swelling with flattening of the knuckle . X-ray : show an impacted transverse fracture with volar angulation of the distal fragment .Treatment : 1- conservative treatment : by manipulation and holding the fracture by splint or p.o.p. in a position the metacarpo-phalangeal joint of the fifth finger is in flexion and the inter phalangeal joints are in extension for a week or two then the hand is mobilized . The patient is warned that the knuckle profile may be permanently lost. 2- If the fracture need fixation this done by percutaneous pinning or by open reduction and fixation by k wire Complication : malunion
Bennett`s fracture-dislocation
This fracture occur at the base of the first metacarpal bone and it commonly due to punching . The fracture is oblique extend into carpometacarpal joint and is unstable . Clinically : the thumb looks short and the carpometacarpal region swollen .Treatment : 1- conservative treatment : by manipulation and p.o.p. but the fracture may redisplaced shortly after reduction because it is unstable . 2- surgical treatment : this done by open reduction and fixation by screw or k -wire and this is the method of choice of treatment .