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Forum Name: Bone trauma and fractures

Question: Rotation (finger crossover) after metacarpal fracture


 xelibri112 - Wed Dec 02, 2009 1:25 pm

Hello, I recently suffered from a boxer's fracture (5th metacarpal) after a dumb accident. The doctor put on a cast that restricted only the pinky finger for about 2 weeks. I've had the cast removed for 3 weeks so far (making it the 5th week after the injury) and the doctor said that I need not return and I just have to do hand excercises that involve making a fistand letting go for a few reps.

I'm experiencing some abnormal rotation and the pinky is crossing over to the ring finger whenever I make a fist... Also, I'm unable to bend my pinky all the way when I make a fist. Will it eventually correct itself if I continue the excercises or do I have to go back to the doctor?
 Dr.M.Aroon kamath - Mon Dec 07, 2009 12:15 am

User avatar Hi,
"Boxer's fracture", bar room fracture or "brawler's fracture" usually is a fracture at the neck of the metacarpal of the little finger (but can also mean fractures of the necks of the other metacarpals as well.

Usually, these fractures are caused by striking a solid object with a closed fist and thus are dubbed boxer fractures, although this fracture almost never occurs during a boxing bout. Expert boxers usually tend to fracture their index metacarpal necks.

You have not mentioned which side was involved and about your 'handedness' (right handed or left handed).This is important in the final decision -making.

Metacarpal neck fractures very rarely require surgery.

Mostly some form of immobilisation of the fracture is required.

Two aspects that are usually taken into consideration are
a) the degree of angulation and
b) minimizing axial rotation.

Whatever casting technique is used, it is essential to "buddy tape" the little and ring fingers (with an intervening layer of padding) in order to control axial malrotation of the fracture.

Although the acceptable degree of angulation at the fracture is controversial, as much as 50-60° of angulation may be tolerated with little or no functional deficit. This level of angulation is especially true for boxer's fractures of the 5th metacarpal neck. Despite acceptable functional results, this degree of angulation usually alters the dorsal knuckle contour and may result in a tender mass
(palmar) with heavy gripping. Though quite unusual, fracture rotation is an indication for surgical intervention.

Your description may indicate some degree of axial rotation.
I suggest that you have to consult your surgeon, who will be in a better position to judge the degree of malrotation (if any) & then to decide if any corrective surgery may be required.

Best wishes!
 xelibri112 - Tue Dec 08, 2009 4:24 am

Hello and thank you for the reply.

I'm right-handed and that's the affected hand. I've been able to bend the pinky fully recently whenever I clench my fist so that's an improvement. However the malrotation still occurs and my pinky seems to force itself over the ring finger whenever I grip onto something with strength. You mentioned that buddy taping is required to prevent malrotation from occuring after the cast is removed but the cast the doctor put on for me only restricted the pinky and there was no buddy taping so I think this was the reason I'm having the problem now.

I won't be able to see the doctor until next week. What I''m anxious to know is if this issue will eventually correct itself and my pinky will be able to fold parallel to the other fingers instead of crossing over the ring finger without surgery?

Thanks again.
 Dr.M.Aroon kamath - Tue Dec 08, 2009 10:21 am

User avatar Hi,
It is very difficult to answer your question without actually examining you. Therefore, your doctor will be the best person who would be able to assess whether surgery may be required or otherwise.

'Buddy-taping' is one form of immobilization.Others may use casts. The underlying idea is the same.

Best wishes!
 xelibri112 - Tue Dec 08, 2009 11:22 am

Hello, I've brought my appointment with the doctor forward to this weekend. Thank you so much for taking the time to reply to my questions.
 xelibri112 - Sat Dec 26, 2009 1:16 pm

Hello again, I met with the doctor and he said that surgery is the only option if I want to correct the malrotation. The surgery involves breaking the bone again and shifting it back into the correct position before fitting screws and a metal plate to make sure it grows back correctly.

What I'd like to know are the cons for this type of surgery? The doctor said that the plate and screw will not be removed even after complete healing as it is too troublesome. Will the movement of my pinky be restricted by the metal plate and screws? Will I be able to regain the full function of my pinky again after the?

Thanks.
 Dr.M.Aroon kamath - Sun Jan 03, 2010 7:07 am

User avatar Hi,

I believe, you stand a very good chance of full recovery after surgery (followed by physiotherapy).

Best wishes!
 xelibri112 - Tue Mar 30, 2010 3:12 pm

Hello again, it's been a few months since I last posted here. I consulted with a doctor about a month ago but somehow I felt that her explanation wasn't clear enough. She said that I should try to adapt to it and that she'd refer me to another doctor if I still find the defect causing inconvenience. I tried looking online about malrotation surgery but I couldn't find anything useful.

Would you kindly describe the procedure and any complications that might arise? Also, are there any side effects from the surgery? Thank you.
 Dr. A. Saif - Tue Apr 20, 2010 12:59 pm

User avatar Dear xelibri,

Any surgery has a risk of complications. Finger mal-rotation surgery is not commonly done and the little finger is able to tolerate mal-rotation more than the other digits. Your surgery is exactly as described previously by yourself...you have a scar about 3-5cm over the metacarpal. The bone is exposed and a saw used to make a cut in the bone. The rotation is corrected and the bone is fixed with a plate and screws. Recovery expect 4- 6 weeks for fracture union and about a couple months of physio/rehab. Complications 1) stiffness.... this is common, and I would say almost guaranteed, and may last several years. Infection - about 1-2% risk of deep infection. Infection in bone is very difficult to get rid of. Nerve injury rare but possibly may give you an area of numbness in your hand, or a painful neuroma. Lump over the osteotomy. This is likely even if the correction is anatomic and largely a result of scar tissue.

I do not recommend correction of little finger unless 1) more than 50% of the little finger tip is covered when making a fist. 2) there is significant difficulty in getting a good grip 3) there is distressing cosmetic deformity. Complications of metal work removal outweigh the benefits from it in most situations.

Cheers

Saif

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