Fractures of Metacarpals & Phalanges
Fractures of the tubular bones of the hand are extremely common. Stability and rotational alignment are the keys to successful treatment.
1. Metacarpal Fractures
- Boxer's Fracture: Fracture of the 5th Metacarpal Neck. Typically from punching a wall.
- Treatment: Ulnar Gutter Splint. Up to 40-degrees of angulation is accepted.
- Shaft Fractures: Spiral or Transverse. Check for scissoring of fingers (rotation).
2. Phalangeal Fractures
- Distal Phalanx (Tuft): Crush injury. Treat hematoma (nail trephination) and splint.
- Proximal/Middle Phalanx: Prone to stiffness. Early motion with Buddy Taping is preferred for stable fractures.
The "Scissoring" Test:
Ask the patient to make a fist. All fingers should point to the scaphoid tubercle. If one finger crosses over another, there is rotational malalignment requiring surgery.
Ask the patient to make a fist. All fingers should point to the scaphoid tubercle. If one finger crosses over another, there is rotational malalignment requiring surgery.
25 Practice MCQs
Q1. Boxer's Fracture involves:
Answer: A). Classic injury from punching.
Q2. Which deformity is NOT tolerated in metacarpal fractures?
Answer: B). Rotation causes fingers to overlap during grip, ruining function.
Q3. Buddy Taping involves:
Answer: A). The healthy finger acts as a dynamic splint.
Q4. Mallet Finger is an avulsion of:
Answer: A). Can involve a bony fragment (Bony Mallet).
Q5. How much angulation is acceptable for a Boxer's fracture (Neck of 5th)?
Answer: A). The CMC joint of the little finger is very mobile and compensates well.
Q6. Seymour Fracture involves:
Answer: A). High risk of infection; requires antibiotics and debridement.
Q7. "Intrinsic Plus" position for splinting involves:
Answer: A). Keeps collateral ligaments taut to prevent stiffness.
Q8. Jersey Finger is:
Answer: A). From grabbing a jersey; usually ring finger.
Q9. Subungual hematoma is treated by:
Answer: A). Relieves the pressure/throbbing pain immediately.
Q10. Tuft fractures of the distal phalanx are usually:
Answer: A). Like getting finger shut in a door.
Q11. Which metacarpal is the most stable/immobile?
Answer: C). The central pillar. 4th and 5th move to cup the hand.
Q12. Volar Plate injury at PIP joint prevents:
Answer: A). Jamming injury causes hyperextension and volar plate avulsion.
Q13. Spiral fractures of the phalanx tend to:
Answer: A). Often require pinning or screws.
Q14. Ulnar Gutter splint is used for:
Answer: A). Immobilizes the ulnar side of the hand.
Q15. Most common complication of phalangeal fractures is:
Answer: A). Tendons run very close to bone; adhesions form quickly.
Q16. Intra-articular condylar fractures of phalanges usually require:
Answer: A). To restore the joint surface.
Q17. Is early motion allowed after pinning?
Answer: A). Pins hold the bone so soft tissues can move.
Q18. "Pilon" fracture of the finger affects:
Answer: A). Axial load causes explosion of the base. Hard to treat.
Q19. Angulation of 2nd and 3rd MC fractures is:
Answer: A). They are rigid pillars; deformity causes a lump in the palm.
Q20. Tendon gliding exercises help prevent:
Answer: A). Vital in hand rehab.
Q21. Epibasal fracture of the thumb is:
Answer: A). Does not enter the joint.
Q22. Which block is best for finger reduction?
Answer: A). Simple and effective. Avoid adrenaline!
Q23. Boutonniere deformity can result from:
Answer: A). PIP flexion, DIP extension.
Q24. How long for clinical union of hand fractures?
Answer: A). Heals fast; prolonged immobilization causes stiffness.
Q25. "Lag screws" are used to:
Answer: A). Interfragmentary compression.
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