Metacarpal Fractures



1.  Neck of 5th Metacarpal

2.  Metacarpal Shaft

3.  Metacarpal Head

4.  Base of Metacarpal Fracture Dislocations

5.  Base of Thumb Fractures / Bennett's / Rolanda


1.  Neck of 5th Metacarpal Fracture


Non operative Management


Accept 45o angulation

- will have finger extensor lag, but will recover

Clavicle Fractures

Clavicle Fracture Displaced



Usually a direct blow 

- less commonly a fall on the outstretched hand


RTA / sporting accidents commonest causes


Can be pathological as a result of radionecrosis

- eg following radiotherapy for breast cancer.  




Fractures of the clavicle are common

Forearm Fractures




- 8 / 52 gestation radius & ulna



- distal radius age 1

- distal ulna age 5


Non Operative Management


Unacceptable Position


< 10:  > 15o malalignment

> 10:  > 10o malalignment


Postreduction Positionin / Rule of Thirds 


Ankylosing Spondylitis



A HLA B27 positive, seronegative spondyloarthropathy with sacroiliac joint & spine involvement

Mainly affects the cartilaginous joints of the axial skeleton


Diagostic Criteria (1966 New York)


1. Positive X-ray Sacroiliitis


Sacroilitis Ankylosing Spondylitis