Metacarpal fractures are common and can be functionally disabling. The majority are managed non-operatively. When surgical intervention is indicated, various methods of fixation are available with the utility of each being based on injury pattern, patient function and surgeon preference. Early mobilization, especially in case of open reduction and internal fixation, is a critical component of treatment to prevent stiffness and restore function. When possible, a fixation construct that can withstand the applied forces of early postoperative motion is chosen. We provide an updated description for diagnosis, treatment options and operative fixation for metacarpal fractures.
AitaMAOliveiraRKBiondiBGBrunelliJPFRuggieroGMDelgadoPJ.Intramedullary fixation with headless screws versus bouquet in unstable metacarpal neck fractures in active patients: a randomized study. Rev Bras Ortop (Sao Paulo). 2021,
56: 717–25.
2.
BaumgartnerREFedererAEGuerreroEMMithaniSKRuchDSRichardMJ.Complications of low-profile plate fixation in metacarpal fractures. Orthopedics. 2021,
44: e91–e4.
3.
BeckCMHoreshETaubPJ.Intramedullary screw fixation of metacarpal fractures results in excellent functional outcomes: A literature review. Plast Reconstr Surg. 2019,
143: 1111–8.
4.
BennettEH.On fracture of the metacarpal bone of the thumb. Br Med J. 1886,
2: 12–3.
BoeckstynsMEH.Current methods, outcomes and challenges for the treatment of hand fractures. J Hand Surg Eur. 2020,
45: 547–59.
7.
BoeckstynsMEH.Challenging the dogma: severely angulated neck fractures of the fifth metacarpal must be treated surgically. J Hand Surg Eur. 2021,
46: 30–6.
8.
De JongeJJKingmaJvan der LeiBKlasenHJ.Fractures of the metacarpals. A retrospective analysis of incidence and aetiology and a review of the English-language literature. Injury. 1994,
25: 365–9.
9.
DoarnMCNydickJAWilliamsBDGarciaMJ.Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: short term results. Hand (N Y). 2015,
10: 314–8.
10.
EdwardsGAGiddinsGE.Management of Bennett's fractures: a review of treatment outcomes. J Hand Surg Eur. 2017,
42: 201–3.
11.
El-ShennawyMNakamuraKPattersonRMViegasSF.Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg Am. 2001,
26: 1030–5.
12.
Esteban-FeliuIGallardo-CaleroIBarrera-OchoaSLluch-BergadàAAlabau-RodriguezSMir-BullóX.Analysis of 3 different operative techniques for extra-articular fractures of the phalanges and metacarpals. Hand (N Y). 2021,
16: 595–603.
FoucherG. “
Bouquet” osteosynthesis in metacarpal neck fractures: a series of 66 patients. J Hand Surg Am. 1995,
20: S86–90.
15.
GalbraithJGHuntingtonLSBorbasPAcklandDCThamSKEkET.Biomechanical comparison of intramedullary screw fixation, dorsal plating and K-wire fixation for stable metacarpal shaft fractures. J Hand Surg Eur. 2022,
47: 172–8.
16.
GhazalaCChoudhryNRajeevA.Closed intramedullary locking nailing for metacarpal fractures: A retrospective study of sixty-six fractures. Malays Orthop J. 2018,
12: 7–14.
17.
HuangJIFernandezDL.Fractures of the base of the thumb metacarpal. Instr Course Lect. 2010,
59: 343–56.
18.
HussainMHGhaffarAChoudryQIqbalZKhanMN.Management of fifth metacarpal neck fracture (boxer’s fracture): A literature review. Cureus. 2020,
12: e9442.
19.
JahssSA.Fractures of the metacarpals: A new method of reduction and immobilization. J Bone Joint Surg Am. 1938,
20: 178–86.
20.
KatayamaTFurutaKOnoHOmokawaS.Clinical outcomes of unstable metacarpal and phalangeal fractures treated with a locking plate system: A prospective study. J Hand Surg Eur. 2020,
45: 582–7.
21.
KhanAGiddinsG.The outcome of conservative treatment of spiral metacarpal fractures and the role of the deep transverse metacarpal ligaments in stabilizing these injuries. J Hand Surg Eur. 2015,
40: 59–62.
22.
Kjaer-PetersenKJurikAGPetersenLK.Intra-articular fractures at the base of the fifth metacarpal. A clinical and radiographical study of 64 cases. J Hand Surg Br. 1992,
17: 144–7.
23.
KollitzKMHammertWCVedderNBHuangJI.Metacarpal fractures: Treatment and complications. Hand (N Y). 2014,
9: 16–23.
24.
McElfreshECDobynsJH.Intra-articular metacarpal head fractures. J Hand Surg Am. 1983,
8: 383–93.
25.
MorwayGRRiderTJonesCM.Retrograde intramedullary screw fixation for metacarpal fractures: A systematic review. Hand (N Y). 2023,
18: 67–73.
26.
NakashianMNPointerLOwensBDWolfJM.Incidence of metacarpal fractures in the us population. Hand (N Y). 2012,
7: 426–30.
27.
NydickJAWilliamsBDGarciaMJ.Retrograde headless intramedullary screw fixation for displaced fifth metacarpal neck and shaft fractures: Short term results. Hand (N Y). 2015,
10: 314–8.
28.
OrbayJ.Intramedullary nailing of metacarpal shaft fractures. Tech Hand Up Extrem Surg. 2005,
9: 69–73.
29.
ReformatDDNoresGGLamG, et al.
Outcome analysis of metacarpal and phalangeal fixation techniques at Bellevue Hospital. Ann Plast Surg. 2018,
81: 407–10.
30.
RolandoS.Fracture of the base of the first metacarpal and a variation that has not yet been described: 1910. Clin Orthop Relat Res. 1996,
327: 4–8.
31.
SlettenINNordslettenLHjorthaugGAHellundJCHolmeIKvernmoHD.Assessment of volar angulation and shortening in 5th metacarpal neck fractures: An inter- and intra-observer validity and reliability study. J Hand Surg Eur. 2013,
38: 658–66.
32.
StrubBSchindeleSSondereggerJSproedtJvon CampeAGruenertJG.Intramedullary splinting or conservative treatment for displaced fractures of the little finger metacarpal neck? A prospective study. J Hand Surg Eur. 2010,
35: 725–9.
33.
TangJBBlazarPEGiddinsGLalondeDMartínezCSolomonsM.Overview of indications, preferred methods and technical tips for hand fractures from around the world. J Hand Surg Eur. 2015,
40: 88–97.
34.
TuncerSAksuNDilekHOzkanTHamzaogluA.Fractures of the fingers missed or misdiagnosed on poorly positioned or poorly taken radiographs: A retrospective study. J Trauma. 2011,
71: 649–55.
35.
VannabouathongCLiPSrikanthVChenMBhandariMKakarS.Comparing the efficacy and safety of metacarpal neck fracture treatments: A systematic review and network meta-analysis. J Hand Surg Glob Online. 2020,
2: 217–25.
36.
WangDSunKJiangW.Mini-plate versus Kirschner wire internal fixation for treatment of metacarpal and phalangeal fractures. J Int Med Res. 2020,
48: 300060519887264.
WormaldJClaireauxHAGardinerMDJainAFurnissDCostaML.Management of extra-articular fractures of the fifth metacarpal: Operative vs. non-operative treatment (FORTE) – a systematic review and meta-analysis. JPRAS Open. 2019,
20: 59–71.
