Right hand pain after a punch

• Published in: BMJ (Online) 2024-02, Vol.384, p.e077406-e077406
• Main Authors: Wang, Xiao-jian, Zhang, Yan-jun, Qin, De-an
• Format: Article
• Language: English
• Subjects: Bone healing; Case reports; Endgames; Fractures; Hands; Immobilization; Metacarpal; Orthopedics; Surgical techniques
• ISSN: 1756-1833; 1756-1833
• DOI: 10.1136/bmj-2023-077406

An intra-articular displaced fracture of the fifth metacarpal base. Reverse Bennett fractures are very unstable owing to the strong, unopposed pull of the extensor carpi ulnaris inserting at the dorso-ulnar aspect of the fifth metacarpal base, which causes the ulnar, dorsal, and proximal migration of the main fracture fragment (metacarpal shaft).45 Surgical fixation is recommended over ulnar gutter cast immobilisation for fractures with metacarpal shortening >3 mm, dorsal angulation >10°, or articular incongruence >2 mm after closed manipulative reduction.6 Learning points Fractures of the fifth metacarpal are the most common hand fractures; boxer’s fractures are more prevalent than basal fractures. A reverse Bennett fracture is an intra-articular fracture of the base of the fifth metacarpal, and may be mistaken for a boxer’s fracture. Patient outcome The patient had open reduction internal fixation with two Kirschner wires (one was directed radially from the fifth metacarpal shaft to the fourth metacarpal shaft with three bony cortices penetration, the other was driven to anchor the fifth metacarpal base) and an augmented miniplate. Surgical outcomes of percutaneous pinning and open locking plating in patients with intra-articular fractures of the base of the fifth metacarpal.