When the joint is flexed to approximately 90° degrees, the collateral ligaments are taut, firmly stabilizing the joint. This results in the collateral ligaments changing length during range of motion. The metacarpal head has a cam-shaped appearance, with the head volar to the axis of the shaft. The MCP joints consist of the metacarpal head and the base of the proximal phalanx. It has a unique, saddle articulation with the trapezium featuring 2 biconcave surfaces, giving the thumb the unique motion of opposition as well as motion in the other 2 planes that helps provide 40% of hand function. The thumb metacarpal has a pronated position relative to the other metacarpals. ,, Additionally, the border (index and small finger) metacarpals are more likely to shorten compared with the long and ring finger because they have fewer soft tissue attachments. The increased mobility of the ring and small finger CMC joints places them at higher risk for fracture and/or dislocation yet also allows for a greater degree of acceptable angulation and displacement after fracture. This discrepancy in CMC joint stability gives the hand the ability to have a strong grasp while at the same time accommodate different-shaped objects. Furthermore, the index and long finger metacarpals essentially are fixed at the CMC joints whereas the ring and small finger CMC joints allow for 15° to 25° of ring and small finger CMC joints, respectively. The index finger metacarpal is the largest in length and diameter whereas the ring finger metacarpal is the smallest in diameter and the small finger metacarpal is the shortest in length. The volar plates ( dark blue ) are interconnected via the deep transverse ligament. The deep transverse metacarpal ligament ( green ) connects the nonthumb metacarpals (not shown) to each other at their distal end. The finger metacarpals articulate with the neighboring metacarpal proximally they are attached to each other via strong interosseous ligaments and distally via the deep transverse metacarpal ligament ( Fig. 1 ). , There are 4 finger metacarpals and 1 thumb metacarpal. The metacarpals form a concave, transverse arch that is fixed proximally via the strong articulations with the distal carpal row at the carpometacarpal (CMC) joints and is more mobile and adaptive distally at the metacarpophalangeal (MCP) joints. The treating surgeon must take into account the specific sport being played, whether the athlete will finish the season, and the return-to-play time in order to proceed with a plan that is in best interest of the athlete. Because of this, thoughtful consideration of the treatment plan and fixation method is warranted for these fractures. Not only are these opportunities at risk in the short term due to loss of playing time from injury recovery but also there is potential risk for long-term functional hand impairment after an athletic career. ,Īthletes represent a unique population due to the high level of physical demand for function and the potential significant monetary impact injury has on players, whether scholarship opportunity for high school or collegiate athletes or loss of income for elite and professional athletes. Hand fractures are the most common fractures sustained by children, and hand and wrist injuries account for up to 17% of sporting injuries in children. Participation in sports during childhood and adolescence has nearly doubled in the United States in the past 4 decades, leading to a similar increase in sporting injuries. ,, Rates of injuries vary by sport, with higher rates in contact sports and approximately half occurring in football. These fractures are more likely to occur in male athletes between the ages of 10 years and 40 years. In the sporting world, injuries to the hand and wrist account for 2% to 9% of all injuries, with some studies reporting that metacarpal and phalangeal fractures account for 39.2% of all sports-related fractures. Metacarpal and phalangeal fractures account for 18% and 23%, respectively, of below-elbow fractures in the general population in the United States and are the most common injuries of the upper extremity. Return to play can be expedited with early fixation, playing casts, and an emphasis on early range of motion. Metacarpal and phalangeal fractures are common injuries in athletes and usually result from low-energy, direct hits to the fingers and thumb.Ĭontact sports, in particular football, account for most metacarpal and phalangeal fractures.Ĭonsideration of the degree of injury, the specific sport, the timing of the injury, the level of play, and the athlete’s goals must be made when developing a treatment plan.
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