Episode 4: Metacarpal Fractures from Casting: the junior Ortho Pod

Casting: the junior Ortho Pod

Ajay Shah

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Episode 4: Metacarpal Fractures

34 minutes Posted Jul 5, 2021 at 2:37 am.

Background (40% of all hand fractures are MC, 80% are MC neck)

Boxer’s (swinging, 5th MC neck)

X-ray principles (3 views, assess angulation [apex dorsal])

Angulation (5th tolerates more, 20/30/40/50-60, biomechanics cause extensor lag)

Reduction via Jahss maneuver (https://www.aliem.com/trick-of-trade-reducing-metacarpal/ - see second video)

Malrotation (scissoring, flexion cascade, fingernails. Scissoring video: https://imgur.com/a/XADr6dI)

Extensor tendons (injury, fight bite, lag, MC head fractures, infections. Always ask what they punched)

How to splint (immobilization in the safe position [see video above], ensure MCPs bent, IPs straight, wrist slightly extended. ORIF = less rigid fixation to allow tendon gliding and no stiffness)

ORIF options (CRPP retrograde, anterograde bouquet technique for distal fractures: https://imgur.com/a/9Sn3Y31)

MC shaft fractures (same exam, same signs. Polytrauma will need rigid fixation to allow hand for rehab/transfer, isolated injury can be nonop. More options for ORIF: IM nail, lag screw, plate/screw construct)

Problem with hand fractures (rigid fixation versus stiffness)

Main complication of MC fractures: pain/weakness with grip due to malrotation

Bennett’s versus 1st MC base versus Rolando fractures (Geometry and deforming forces: https://imgur.com/a/jl6lMBN, APL as main deforming force. Treat with CRPP + traction/pronation)

Case (Demographics: Age/Sex/Handedness/Smoking/Occupation, Injury: Mechanism/DOI, Symptoms: Numbness/Paraesthesia/Pain, Exam: Extensor Lag/Malrotation/NV status)

Patient factors inform management

https://sketchymedicine.com/

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Show notes

Metacarpal Fractures

Dr. Alison Wong (Founder of: https://sketchymedicine.com/, Dalhousie Plastic Surgery graduate, Hand Surgery fellow at Shock Trauma, Baltimore) talked with me about Metacarpal Fractures. High-yield takeaways are the recognition of common MC fracture patterns and their mechanisms, assessing angulation/malrotation, performing a standard Jahss reduction maneuver, and balancing fixation with movement to prevent stiffness.

Timestamps:

8:00 - Reduction via Jahss maneuver (https://www.aliem.com/trick-of-trade-reducing-metacarpal/ - see second video)

9:00 - Malrotation (scissoring, flexion cascade, fingernails. Scissoring video: https://imgur.com/a/XADr6dI)

17:30 - ORIF options (CRPP retrograde, anterograde bouquet technique for distal fractures: https://imgur.com/a/9Sn3Y31)

27:15 - Bennett’s versus 1st MC base versus Rolando fractures (Geometry and deforming forces: https://imgur.com/a/jl6lMBN, APL as main deforming force. Treat with CRPP + traction/pronation)

34:30 - https://sketchymedicine.com/

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