1.  Neck of 5th Metacarpal

2.  Metacarpal Shaft

3.  Metacarpal Head

4.  Base of Metacarpal Fracture Dislocations

5.  MCPJ dislocations


1.  Neck of 5th Metacarpal Fracture


Non operative Management


Accept 45o angulation

- will have finger extensor lag, but will recover

- can ring block and manipulate in POSI cast to improve position


Neck of Fifth Metacarpal Fracture


Operative Treatment



- K wire across MC head into 4th MC


2.  Metacarpal Shaft Fracture


Acceptable Deformity


Rotation < 5o

10o / 20o / 30o / 40o in IF / MF / RF / LF

< 5 mm shortening


Metacarpal Fracture Minimally Displaced


Operative Management



- plate

- lag screws (if spiral fracture)

- intramedullary wires


Metacarpal Intramedullary Wires


3.  Metacarpal Head Fracture



- uncommon

- usually in index finger


Indication for surgery

- > 2mm angulation



- T plate

- headless compression screws / intra-articular


4.  Base of Metacarpal Fracture Dislocations


Metacarpal Base Fracture Dislocation LateralBase of Metacarpal Dislocation CT



5. MCPJ Dislocation



- volar plate not interposed



- volar plate, lumbricals, flexor tendons interposed

- open reduction