Management of Metacarpal Fractures

8 Dec
  • These fractures account for 40% of all hand injuries
  • treatment based on which metacarpal and the acceptable angulation of the fracture; general rules to remember:
    • index 10°
    • long 20°
    • ring  30°
    • little 40°
  • physical exam pearls:
    • fight wounds over MCP joint are open until proven otherwise
    • assess malrotation by examining “cascade” -> line up fingernails while fingers in full flexion



  • reduction and splinting if acceptable angulation and no immediate operative indications
    • “jahss” technique for reduction -> flex the patient’s MCP and PIP 90°, then apply dorsal force to proximal phalanx


    • intrinsic plus technique for splinting -> MCP flexed to 60-70°, IP fully extended, and wrist held in 10° less than maximal extension.


Submitted by Kelly Estes.


Sources: Content and Picture1 (, Picture 2 (


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