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Outlines current management of upper limb conditions in primary care settings

This information is for primary care physicians and a general summary of current practice 

Please consult a physician directly for management of specific injuries  

2nd - 5th Metacarpal Fractures: Indications for Operative Management 

Mechanism of Injury: Fall onto outstretched hand, direct impact to metacarpals (crush injury) or direct blow to metacarpal heads (i.e punch injury)

Consideration: 4th and 5th MC's are more mobile and therefore more unstable compared to 2nd and 3rd MC's

Associated injuries: Extensor tendon injury

Rotation of Metacarpal Fractures

  • No rotation tolerated as it impacts functional use of the fingers (i.e gripping, fine motor and pinch)

  • Difficult to assess on x-ray

  • Assess by having patient make a fist (if tolerable for patient)

Intra-articular Metacarpal Head Fractures 

  • Some MC neck fractures impact the MCP joint and require fixation

  • Can be misdiagnosed as a boxers fracture (5th MC neck fracture)


Rotation of the 5th  metacarpal fracture leading to scissoring of the little finger

Compound Metacarpal Fracture

  • Skin breached

  • Exposed fracture

  • Open wound

Multiple Metacarpal Fractures

  • Stability of metacarpals is reinforced by adjacent metacarpals and soft tissues

  • Multiple metacarpal fractures reduce stability and increase the risk of fracture migration


Multiple Metacarpal Fractures 

Dorsal Angulation of Metacarpal Fractures

  • 4th and 5th metacarpals are quite mobile compared to 2nd and 3rd metacarpals and can tolerate a higher degree of dorsal angulation with minimal functional impact to patients

  • See table

Shortening of Metacarpal Fractures 

  • Up to 6mm shortening tolerated at all metacarpals

  • Can lead to loss of metacarpal head prominence in a fist

    •  consideration for patients who participate in boxing or fighting sports

  • Potential risks include an extensor lag of the MCPJ


ULQ specialists are available to see patients and assess the above.

If patients require non-operative management, we are able to directly refer them to hand therapy for protective splinting.

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