Joseph’s Regional Medical Center. Paterson, NJ. X-rays are quite difficult to sketch using a pencil crayon! ** Please keep in mind that this is just a quick doodle. However, some researchers believe the threshold for fifth metacarpal fractures should also be 30 degrees”. As described in the Uptodate article, “The second metacarpal neck tolerates 10 degrees of angulation, the third 20 degrees, the fourth 30 degrees, and the fifth metacarpal up to 40 degrees of angulation without adversely affecting functional outcome.
Here is a simple rule to determine if surgical management is required based on angulation, it is called the “10, 20, 30, 40 rule”. Internal fixation with plates is the last resort. K-wire fixation may be required if reduction cannot be maintained.
Most closed metacarpal neck fractures can be treated non-operatively with dorsal block cast or ulnar gutter splint for ~4 weeks. In addition to the 6-A’s, don’t forget to comment on the ABCs: Adequacy (confirm patient ID, date, exposure, views), Bones (look for other fractures, lesions, evidence of disease such as OA), Cartilage and Soft-tissues. Apposition: Describe the amount of end to end contact of the fracture fragments.apex medial, apex valgus) should also be included. Apex: In addition to describing the degree of angulation, the direction the apex is pointing relative to anatomical long axis of the bone (e.g.Angulation: Is there any rotational deviation from normal alignment? If yes, describe the angulation in degrees of the distal fragment in relation to the proximal fragment.Alignment: What is the relationship of the longitudinal axis of one fracture segment, or bone, to another? (Alignment is often used interchangeably with the term “dislocation”).Articulation: Does the fracture involve the articulating surfaces of a joint?.Anatomy: Where is the fracture located? What type of fracture is it: transverse, oblique, comminuted, impacted…)?.Approximately three to four weeks after breaking an arm, the fractures will be healed. There are many teenagers who have it on their minds. Here is a mnemonic to help remember an approach to describing a fracture on an x-ray, “Comment on the 6-A’s”: In the Boxer’s Fractures we see striking something with the left hand with such force that we believe may cause the injury, which in turn happens to our hand. Experienced boxers rarely sustain this type of fracture, and the term “boxer’s fracture” is therefore a misnomer”. The “roundhouse” punching motion common in street fights (but rare in professional or high level amateur boxing) generally transmits significant force to the fifth metacarpal, resulting in fracture. Mechanism of injury: “Direct trauma to a clenched fist, such as punching a wall or solid object. Boxer’s fractures account for ~10% of all hand fractures. This Daily Doodle illustrates a Boxer’s Fracture, a fracture across the distal neck of the fifth metacarpal bone.