Fracture healing stages

The fifth metacarpal fracture

The fifth metacarpal fracture, commonly referred to as a boxer's fracture (neck of 5th metacrpal fracture), is a common hand injury that occurs as a result of a direct blow to the hand. This type of injury is often seen in athletes and individuals involved in physical activities that require hand use. The management of 5th metacarpal shaft fractures involves different treatment modalities, including conservative management and surgical intervention. In this article, we will discuss the management of 5th metacarpal shaft fractures in detail.

Mechanism of injury

Typically occurs due to direct trauma or a punching motion with a closed fist. It is a common injury seen in athletes, especially those involved in combat sports such as boxing, karate, or mixed martial arts. However, it can also occur in non-athletic situations, such as a fall or car accident where the hand is impacted forcefully.

Initial Evaluation

When a patient presents with a suspected 5th metacarpal shaft fracture, the initial evaluation should include a comprehensive history and physical examination. This includes assessing the mechanism of injury, level of pain, range of motion, grip strength, and any associated injuries. Radiographs, including anteroposterior, oblique, and lateral views, should also be obtained to confirm the diagnosis and assess the severity of the fracture.

Conservative Management

Conservative management is an option for stable, non-displaced fractures of the 5th metacarpal shaft. This involves immobilizing the hand and wrist with a splint or cast for approximately 3-6 weeks, depending on the severity of the fracture. During this time, patients are advised to avoid any activities that may cause stress to the affected hand. Pain management and regular follow-up visits with a healthcare provider are also recommended.

Surgical Management

Surgical intervention may be necessary in cases of displaced or unstable fractures of the 5th metacarpal shaft. The surgical approach may involve closed reduction and percutaneous pinning, open reduction and internal fixation, or external fixation.

Closed reduction and percutaneous pinning is a minimally invasive procedure that involves realigning the broken bone fragments and stabilizing them with pins that are inserted through the skin. This procedure is typically performed under local anesthesia and can be done on an outpatient basis.

Open reduction and internal fixation involves surgically exposing the fracture site and realigning the bone fragments using screws, plates, or wires to stabilize the fracture. This procedure is usually performed under general anesthesia and requires a longer recovery period than closed reduction and percutaneous pinning.

Postoperative Care

After surgical intervention for a 5th metacarpal shaft fracture, postoperative care is essential to ensure proper healing and recovery. Patients are usually advised to wear a splint or cast for approximately 2-6 weeks, depending on the type of surgery performed. Physical therapy may also be recommended to improve range of motion and strength in the affected hand.

Complications

Complications associated with 5th metacarpal shaft fractures can include malunion (improper healing), nonunion (failure to heal), infection, and stiffness in the affected hand. Patients should be advised to seek medical attention immediately if they experience any signs of infection, such as redness, swelling, or fever.

Conclusion

In conclusion, the management of 5th metacarpal shaft fractures involves a comprehensive evaluation, including history, physical examination, and radiographic imaging. Conservative management is an option for stable, non-displaced fractures, while surgical intervention may be necessary for displaced or unstable fractures. Postoperative care is essential to ensure proper healing and recovery, and patients should be advised of potential complications and instructed to seek medical attention if they experience any adverse symptoms.