Hand Fractures

METACARPAL FRACTURES
Metacarpal Neck Fractures
Attempt M&R at the A&E
<15 angulation for 2nd and 3rd metacarpals acceptable <40-45 angulation for the 4th and 5th metacarpals acceptable If able to achieve satisfactory reduction : backslab, analgesics, TCU Ortho SOC 1/52 If unable to achieve satisfactory reduction : Admit to Ortho Dept for surgery Metacarpal Shaft Fractures
Attempt M&R at the A&E
2nd, 3rd and 4th metacarpal fractures:
Usually stable; crepe bandage, analgesics, TCU Ortho SOC 1/52
1st or 5th matacarpal fractures:
If undisplaced or minimally displaced, full POP, analgesics, TCU Ortho SOC 1/52
If still grossly displaced after M&R, Admit to Ortho Dept for surgery
Metacarpal Base Fractures
2nd, 3rd and 4th MCs:
Usually minimally displaced; backslab, analgesics, TCU Ortho SOC 1/52
5th MC base fracture:
If minimally displaced, backslab, analgesics, TCU Ortho SOC 1/52
If still grossly displaced after M&R, admit to Ortho Dept for surgery
Extraarticular 1st MC base fracture :
If minimally displaced: Full POP, analgesics, TCU Ortho SOC 1/52
If still grossly displaced after M&R: admit to Ortho Dept for surgery
Bennett's fracture/ Rolando fractures:
Fracture-dislocation of the CMC joints, unstable injuries; admit to Ortho Dept for surgery
PROXIMAL AND MIDDLE PHALANGES FRACTURES
Attempt M&R under digital block
Extraarticular fractures:
If minimally displaced, Zimmer splint/buddy-tapping, analgesics, TCU Ortho SOC 1/52 to put hand in the intrinsic plus position.
If still displaced, buddy-tapping, admit to Ortho Dept for ORIF
Intraarticular fractures :
If undisplaced, Zimmer splint, analgesics, TCU Ortho SOC 1/52
If still displaced, Zimmer splint, admit to Ortho Dept for surgery

DISTAL PHALANX FRACTURES
Dorsal lip fracture/Mallet finger
Zimmer splint in slight hyperextension, analgesics, TCU Ortho SOC 1/52
Volar lip fracture
Buddy-tapping, admit to Ortho Dept for ORIF
Extra-articular fractures
Closed reduction and buddy-tapping, analgesics, TCU Ortho SOC 1/52