Non-thumb metacarpal fracture (base)
Background
- Reverse Bennett: fracture of fifth metacarpal base, with extensor carpi ulnaris traction on distal metacarpal while proximal fragment still algined with carpals
- See Thumb fracture for Bennett fracture
Clinical Features
- Movement at the wrist elicits pain
- Assess for ulnar deficits (finger abduction/adduction)
- Assess for rotational alignment
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
- Xray hand: AP, lateral, oblique
- 30 deg obliques pronated and supinated if usual films unable to visualize the MC bases
- Consider CT if index of suspicion high for occult fracture despite "negative" plain films
Management
- Dorsal and Forearm Volar Splint with the wrist in 30 deg of extension and MCP joints free
Disposition
- Refer for:
- Intraarticular fracture
- Extraarticular fracture with malrotation
- Dislocation of metacarpal base CMC joint;
- Ulnar nerve injury
- 5th metacarpal base fracture (typically require surgery)