3. Primary survey
A : can speak, can flex neck
B : no dyspnea, equal breath sound both
C : BP 152/94 mmHg, PR 900 bpm
D : E4V5M6
E : Mild edema, tender at MCB area, limit ROM
due to pain, no wound
4. Secondary survey
A : no drug allergy
M : no current medication
P : no U/D
L : Last meal 6 hr PTA
E : as above
5. Physical examination
GA : A Thai man, alert
HEENT : not pale conjunctivae, anicteric sclerae
CVS : full regular pulse, normal S1 S2, no
murmur
Chest : Equal breath sound both lung
Abdomen : soft, not tender
6. Physical examination
Ext : Left hand
- mild edema at dorsum and volar side of
MCB, no wound, normal alignment of fingernails
- Tender on palpation at MCB area
- Limit ROM due to pain
- Neurovascular intact
11. Management
MO 4 mg IV stat
Close reduction
On short arm volar slab in flexion MCP 90˚c
left arm
On arm sling Left arm
Discharge นัด F/U 1wk พร้อม Film left hand
AP,oblique
17. Metacarpal bone fracture
divided into fractures of metacarpal head, neck, shaft,
base
treatment based on which metacarpal is involved and
location of fracture
acceptable angulation varies by location
no degree of malrotation is acceptable
18. Epidemiology
Incidence : metacarpal fractures account for 40% of all
hand injuries
Location : metacarpal neck is most common site of
fracture, fifth metacarpal is most commonly injured
19. Mechanism of injury
direct blow to hand or rotational injury with axial load
high energy injuries (ie. automobile) may result in
multiple fractures
20. Physical exam
inspect for open wounds and associated injuries
fight wounds over MCP joint are open until proven otherwise
extensor tendon can be lacerated and retracted
dorsal wounds over metacarpal fractures are almost always open
fractures
deformity indicates location
deformity at metacarpal base may indicate CMC dislocation
shortening can be assessed by comparing contralateral hand
malrotation assessed by lining up fingernail in partial flexion and full
flexion if possible, compare to contralateral side
21.
22. Physical exam
motor examination
typically no motor deficits unless open wounds present
check integrity of flexor/extensor tendons in presence of open wounds
neurovascular examination
dorsal wounds may affect dorsal sensory branch of radial/ulnar nerve
volar wounds can involve digital nerves, test for radial and ulnar border
two-point discrimination on the injured digit before any
regional/hematoma block or attempted reduction
Metacarpal head : The Brewerton view (metacarpophalangeal [MCP] joint flexed 65° with the dorsum of the proximal phalanx flat against the radiograph cassette and the beam angled 15° ulnar to radial) profiles the collateral recesses and is helpful for collateral ligament avulsion fractures