xrays

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 45^o angulation

- will have finger extensor lag, but will recover

Aetiology

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

History

Initially

- lose velocity / accuracy

Develop medial pain

40% ulna nerve symptoms

Aetiology

Intrinsic

- inflammatory

- degenerative

Extrinsic

- traumatic

- spur

Epidemiology

F > 40

Associations 60% of cases  

- hypertension

- diabetes

- obese

- trauma 

- prior surgery

- steroids

History

First generation (late 70s early 80s) 

Results

1.  Pattern of bone destruction

Geographic

Least aggressive

- usually indicative of slow growing lesion

- usually seen in benign tumours

- may be myeloma / mets / OM

Narrow transition from normal to abnormal bone

- Margin of the lesion is well defined

- margin is easily separated from surrounding bone

- margin may be smooth / irregular, sclerotic / non  sclerotic

Mechanism

FOOSH

- valgus injury

- don't get radial head fracture as is mostly cartilaginous

Types

SH 1 or 2

Associated Injuries

MCL injury

Olecranon / Medial epicondyle fracture

Definition 

Avascular necrosis & subsequent disintegration of lunate

Aetiology

50-75% history of trauma

Occasionally seen in sickle cell / steroid use

Pathogenesis

Vascular Theory

Trauma disrupting vascularity

- single incident with disruption of blood supply

Definition

Intra-articular proximal ulna fracture

Anatomy

Articulates with trochlea

- may have a central bare area

Triceps insertion

- via broad aponeurosis which blends with anconeus and CEO

Management

Non operative Management

Undisplaced fracture

- need to ensure triceps mechanism is intact