![]() Occult metacarpal fractures require an early computed tomography (CT) scan for prompt diagnosis. Kocaoğlu S and colleagues recently suggested the use of ultrasonography for detecting metacarpal fractures in the emergency department. Angulation should be measured at more than 15 degrees, as the normal angulation of the fifth metacarpal neck is 15 degrees. ![]() Plain X-rays (anteroposterior, lateral, and oblique) are the gold standard for diagnosis and for determining angulation (Figures (Figures1 1- -2). Early thorough debridement and antibiotics are required for patients with fight bites, as amputation might be required in certain cases with chronic bone and tendon sheath infection. While examining a potential fifth metacarpal fracture, a clinician must give special attention to check for any breaks in the skin (fight bites), neurovascular status, pseudo clawing, or rotational alignment, and the uninjured hand should be compared. The neurovascular bundle runs adjacent to a metacarpal and may become damaged in displaced fractures, which requires surgical intervention. Like any other long bone fracture, metacarpal bone fractures also follow the same descriptive classification pattern, i.e., open or closed, intraarticular or extra-articular, oblique, spiral, transverse, or comminute. ![]() A boxer's fracture is typically a result of direct trauma to a clenched fist where energy is transferred through the fifth metacarpal axially and mostly results in apex dorsal angulation due to the pull of the interosseous muscles of the hand. ![]()
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