ANATOMY, EPIDEMIOLOGY, DIAGNOSIS, MANAGEMENT AND TREATMENT OF THE METACARPAL FRACTURES

Abstract

Introduction: The fracture of the neck of the fifth metacarpal, also known as "boxer's fracture", is one of the most frequent traumatic pathologies seen in the emergency department and is usually treated with conservative measures. The fifth metacarpal is the most frequently fractured, representing almost 25% of all metacarpal fractures and 10% of all fractures.

Objective: to define and explore the anatomy, epidemiology, approach, diagnosis, management and treatment of metacarpal fractures.

Methodology: a total of 40 articles were analyzed in this review, including review and original articles, as well as cases and clinical trials, of which 26 bibliographies were used because the information collected was not important enough to be included in this study. The sources of information were Cochrane, PubMed and Google Scholar, SciElo; the terms used to search for information in Spanish, Portuguese and English were: fractura del boxeador, fratura do metacarpo, fracture of the fifth metacarpal and boxer's fractures.

Results:  About 30% of all hand fractures and 18% of all below-elbow fractures are metacarpal fractures. Small-finger neck fractures and ring-finger shaft fractures are among the most frequent metacarpal fractures.To diagnose the boxer's fracture and evaluate the degree of angulation, plain radiographs are the gold standard. Fractures with significant angulation require closed reduction and splinting.  Surgical management can result in hardware-related issues such as adhesions, infection, and tendon rupture, whereas a more conservative approach may result in malunion or stiffness due to immobilization.

Conclusions: Uncomplicated fractures of the fifth metacarpal are usually treated with immobilization and splinting or neighboring strapping, with a comparable degree of functional outcome. In Metacarpal head fractures nonoperative treatment options include immobilization in the intrinsic plus position. Small finger metacarpal neck fractures are the most typical and are frequently referred to as "boxer's fractures''. Metacarpal fractures that have no associated rotational deformity can typically be managed conservatively with immobilization and serial radiographs. The use of the Jahss maneuver can result in reduction of fractures with rotational deformity or pseudoclawing. The most common types of metacarpal shaft fractures are transverse fractures, oblique fractures, and comminuted fractures. Operative intervention should be taken into consideration if there is pseudoclawing, rotational deformity, significant metacarpal shortening, or a noticeable dorsal deformity. Despite being a rare injury, intra-articular base fractures of the index- through ring-finger metacarpals have been suggested to be an underreported and misdiagnosed condition. Complications related to these injuries are prevalent and may result from surgical or non-surgical treatment of the initial injury.