Metacarpal fracture

Last revised by Bahman Rasuli on 27 Nov 2022

Metacarpal fractures are common accounting for 10% of all fractures and 40% of all hand fractures

Specific names are given to fractures of the base of the first metacarpal (see: fractures of the thumb):

Specific names are given to fractures of the fifth metacarpal:

The lifetime incidence of a metacarpal fracture is 2.5% ref. Fractures of the 5th metacarpal make up 25% of all metacarpal fractures (which equates to 10% of all hand fractures) ref

They are a result of direct or indirect trauma with the nature and direction of the force being directly related to the type of injury. Specific injury patterns include ref:

  • carpometacarpal (CMC) joint injury

    • metacarpal base fractures and dislocation of the CMC joint

  • metacarpal shaft and neck fractures

    • these are usually a result of axial loading or direct trauma (clenched fist and solid surface); torsional force may also result in this type of injury

  • metacarpal head injury

    • these are intra-articular fractures that result from axial loading or direct trauma; collateral ligament avulsion fractures are caused by forced deviation of the flexed metacarpophalangeal joint (MCPJ).

  • metacarpophalangeal joint dislocations

    • dorsal MCPJ dislocations are the most frequent and a result of forced hyperextension of the digit

  • in children, consider pseudoepiphysis at the base 2

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Cases and figures

  • Case 1: 5th metacarpal fracture
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  • Case 2: 5th metacarpal fracture
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  • Case 3: 5th metacarpal fracture
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  • Case 4: 4th metacarpal fracture
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  • Case 5: undisplaced spiral of 4th and 5th shafts
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  • Case 6: 5th metacarpal fracture
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  • Case 7: 4th metacarpal fracture
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  • Case 8: acute 4th and old 5th metacarpal fractures
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  • Case 9
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  • Case 10: 2nd to 5th metacarpal fractures
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  • Case 11
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  • Case 12: 4th metacarpal fracture
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