First metacarpal fracture

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Case
This U-20 age-group goalkeeper presents with an acute onset of thumb pain. He reports being struck on the thumb awkwardly by a strong shot. He has localised tenderness over the thumb metacarpal with modest swelling. There was no visible deformity (and especially no rotational deformity).

Findings
An x-ray image shows an undisplaced trnsverse fracture through the proximal shaft of the thumb metacarpal. This does not appear to involve the joint. Serial x-rays (take one month later) show a maintained position

Discussion
This patient was successfully treated with a six week period in a thumb spika splint. He was allowed to train as able in the splint.

Some thumb metacarpal injuries can be difficult to manage. Fractures can be classified into two groups depending on whether they are stable or unstable. Unstable fractures involve the carpo-metacarpal (CMC) joint. In this situation the thumb abductors and extensors act to produce subluxation. Bennett’s fractures involve displacement of the metacarpal shaft radially and dorsally, while the volar fragment remains intact, due to an intact volar ligament. Rolando fractures are comminuted fractures of the base of the first metacarpal. These injuries are genrally managed with surgical treatment. Stable fractures (like the one in this case) don’t involve the joint and include fractures of the proximal metacarpal shaft and epiphyseal plate fractures. These can generally be managed in a splint or cast.

Important notice
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Bangoura
21 juillet 2018 12:18

La fracture du 1er metacarpien chez un gardien de but en général entraîne un suivi très sérieux
En première intention la radiographie de la main en face etprofil
Sl la fracture est confirmée non déplacée sans atteinte de l articulation on procède à l immobilisation plâtre de 6 a8 semaines avec repos
Radio de contrôle si la consolidation est parfaite on commence la rééducation
La reprise est progressive