Fourth metacarpal fracture

Case
A 23-year-old male player presented after a collision with an opponent. He describes experiencing immediate pain as his hand was caught in his opponent’s shirt. He was however able to play a further 30 minutes without much restriction. After the game, he was noted to have localised tenderness over his fourth metacarpal as well as pain with gripping tasks. There was no rotational deformity.

Findings
An x-ray series of the right hand shows that the fourth metacarpal has an oblique fracture of the proximal shaft with mild overlap and separation but no significant angulation.

Discussion
This player was treated with a four week period of immobilisation. He was managed in a thermoplastic splint that allowed him to continue to play and train. Repeat x-rays at two weeks and four weeks post-injury showed that the fracture position had been maintained and demonstrated evidence of fracture healing.

Metacarpal fractures account for about 40% of all hand fractures. They generally occur after a direct blow to the hand or due to a rotational injury with an associated axial load.  The majority of fractures involve the 5th metacarpal with the ‘neck’ being the most common single site.

The treatment of choice for metacarpal fractures is based on which metacarpal is involved, the presence of any ‘clinical’ rotation and the presence of angulation. The acceptable degree of angulation depends on the location. Angulation is tolerated better on the ulnar side of the hand. Up to 40° of angulation can be allowed when the fifth metacarpal is involved, 30° at the ring finger and 10-20° at the middle and index fingers. Fractures involving the neck, rather than the shaft, of the 4th (30-40°) and 5th (50-60°) metacarpals can have more angulation. A clinical assessment must exclude rotation as this is not tolerated well.

Non-surgical treatment can be used for most injuries. The hand should be immobilised in 70-90 degrees of MCPJ flexion for four weeks. When there is a rotational deformity, when multiple fractures are present or when there is significant displacement or angulation operative treatment should be considered.

Important notice
FIFA does not bear any responsibility for the accuracy and completeness of any information provided in the “Radiology Review” features and cannot be held liable with regard to the information provided or any acts or omissions occurring on the basis of this information.

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HADEROعبدالله احمد محمدasfandDr Towseef Ahmad MalikBangoura Recent comment authors
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Bangoura
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Bangoura

LA FRACTURE DE STRESS OU FATIGUE EST UNE FRACTURE OSSEUSE INCOMPLETE PROVOQUEE PAR UNE CHARGE MECANIQUE DE FORTE INTENSITE ET REPETEE.ELLE SE TRADUIT PAR UNE FISSURE AU NIVEAU DE L OS. ELLE N EST PAS LIEE A UNE LESION TRAUMATIQUE. LA FRACTURE DE STRESSCONCERNE LE PLUS SOUVENT LES OS SUPPORTANT LE POIDS DU CORPS. LES MEMBRES INFERIEURS SONT PLUS SOLLICITES LA RADIOGRAPHIE N EST PAS TELLEMENT EFFICACE POUR LE DIAGNOSTIQUE . L IRM LE SCANER ET LA SCINTIGRAPHIE SONT MIEUX INDIQUEES. FAIRE UNE CALCEMIE POUR DOSER LE TAUX DU CALCINM CAR UN DEFICIT EN CALCIUM ET VITAMINE D PEUT OCCASIONNER… Read more »

Jamaleddine almouhandiz
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Jamaleddine almouhandiz

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BOULBABA NEILY
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BOULBABA NEILY

Sports is very important for everyone

bangoura
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bangoura

CONTRAÎREMENT A L OS NAVICULAIRE L OS DU 5e METATARSIEN QUI SONT DES OS MAL IRRIGUE LE 4e METACARPIEN EST TRES BIEN IRRIGUE DONC RAPIDITE DE CONSOLIDATION EN CAS DE FRACTURE. 80% DES FRACTURES SONT TRAITES ORTHOPEDIQUEMENT TRAITEMENT ORTHOPEDIQUE SI LA FRACTURE EST STABLE ÉT NON DEPLACEE. EN CAS DE DEFORMATION EN ROTATIION EN CAS DE FRACTURES MULTIPLES OU EN CAS DE DEPLACEMENT OU ANGULATION IMPORTANTE UN TRAITEMENT CHIRURGICAL DOIT ETRE ENVISAGE. LA REEDUCATION POUR NE PAS PERDRE LA FONCTIONNALITE DE LA MAIN. RISQUE DE RAIDEUR ET D ANKYLOSE. RESPECT DES 2 FONTIONS DE LA MAIN LA PREHENSION ET LA… Read more »

bangoura
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bangoura

LA DUREE DU TRAITEMENT ORTHOPEDIQUE N EXCEDE PAS O3 MOIS AVEC ATTELLE OU PLATRAGE

Bangoura
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Bangoura

LIRE EN PLACE ET LIEU LE TRAITEMENT ORTHOPEDIQUE EST DE 04 SEMAINES AU LIEU DE 03 MOIS

Dr Towseef Ahmad Malik
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Dr Towseef Ahmad Malik

hello this is dr malik

Muhammad
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Muhammad

wasalm are u dr tauseff pcb doc?

عبدالله احمد محمد
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عبدالله احمد محمد

هو لو الكسر ف اي صابع غير دا هيتم التعامل معاه بنفس الإجراءات دي

عبدالله احمد محمد
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عبدالله احمد محمد

لو الإصابة ف صابع غير دا هيتم التعامل معاه بنفس الإجراءات دي

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