An in-depth review of metacarpal fractures.

If you're interested in orthopedics you'll definitely want to check this review out!

What is an eponym for this fracture? Image
This patient is presenting with an intraarticular fx of the 5th metacarpal base.

This fracture is similar to a Bennett's fx (an intraarticular fx of the 1st metacarpal base).

This fracture goes by a few eponyms: a reverse bennett, baby bennett, or mirrored bennett. Image
A Ronaldo fracture is a comminuted fracture of the 1st metacarpal base. (shown above)

Displacement of a Reverse Bennett fracture is due to which of the following muscles?
Displacement of a Bennett's fracture is due to the abductor pollicis longus.

Displacement of a Reverse Bennett's fracture is due to the extensor carpi ulnaris. Image
When assessing a pt with a metacarpal fx there are a few things you want to look for:

First, is there an abrasion on the hand, specifically over the MCP. This may indicate a "fight-bite" injury. These injuries are contaminated with oral flora & should be treated with antibiotics
Second, you should perform a neurovascular exam to rule out injury to digital nerves/vasculature.

Third, you should assess for deformity. This can be performed by having the patient flex their digits towards the scaphoid tubercle and looking for overlap. (Shown below) Image
A Boxer's fx occurs when an amateur fighter strikes an object with a flexed wrist resulting in a fracture of the 4th or 5th metacarpal.

If a trained fighter were to fracture a metacarpal it would occur in the 2nd or 3rd metacarpal because they would strike with a neutral wrist. Image
Angulation tolerances for metacarpal shaft fx:
✯ 2nd/3rd: 20°
✯ 4th: 30°
✯ 5th: 40°

Angulation tolerances for metacarpal neck fx:
✯ 2nd/3rd: 15°
✯ 4th: 40°
✯ 5th: 60°

2-5 mm of shortening may be acceptable.
Malrotation is not acceptable Image
Patients presenting with metacarpal fx may be splinted in an intrinsic plus or "Edinburgh" position:

Wrist slightly extended 15-30°
MCPs are flexed at 80-90°
PIP/DIPs are extended

This is done to help reduce stiffness because the collateral ligaments are shortest in extension. Image
Operative treatment involves closed reduction with percutaneous pinning "CRPP" (left) or ORIF with plate and screws (right).

This depends on the fracture type e.g. comminuted fractures may require ORIF or if reduction cannot be maintained with CRPP. ImageImage
✯ Stiffness: early ROM is important!
✯ Malunion: cosmetic or functional deformity
✯ Infection: look for fight bite injuries
#Rolando not #Ronaldo 🤦🏻‍♂️. Had football in mind..

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More from @Ortho_Reviews

Feb 14
An in-depth review of pediatric femoral shaft fractures.

If you're interested in orthopedics or pediatrics you'll definitely want to check this review out!

1/10 Image
Pediatric femoral shaft (PFS) fractures constitute a small portion of pediatric fractures roughly 1-2% with a bimodal age distribution

Most common causes:
✯ Toddlers: falls
✯ Teenage/adolescent: MVA
In children younger than walking age child abuse must be suspected. As high as 80% of PFS fractures in this age group are due to child abuse.

In the toddler age group as high as 25% of PFS fractures are due to child abuse, so it must be ruled out.
Read 11 tweets
Feb 12
An in-depth review of Slipped Capital Femoral Epiphysis (SCFE).

If you're interested in orthopedics or pediatrics you'll definitely want to check this review out!

1/ Image
SCFE’s are an adolescent hip pathology with an average age of onset of 11-12.

The diagnosis may be initially missed because the patient may present with thigh or knee pain.
Risk factors include:
✯ Obesity
✯ Male gender
✯ Prior radiation
✯ Endocrine abnormalities
✯ Certain ethnicities (e.g. African American)

Obesity is one of the most important and modifiable risk factors.
Read 12 tweets
Feb 5
An in-depth review of Distal Radius Fractures.

If you're interested in orthopedics, you'll definitely want to check this review out.

1/15 Image
Distal radius (DR) fractures have a bimodal age distribution. “accounting for around 25% of fractures in the pediatric population and up to 18% of all fractures in the elderly age group.” (2)

Which of the following does not articulate with the radius?
Read 18 tweets
Sep 21, 2020
Meniscus injury: a complete review.

@MedTweetorials @RosenelliEM
#MedEd #OrthoTwitter #Tweetorials
The meniscus function is two-fold. It increases stability by deepening the tibial surface and it aids in force transmission by increasing the contact area to spread force over a larger surface area. The meniscus is responsible for 50% of load transmission across the knee. (1)

The lateral meniscus has a more circular shape than the C-shaped medial meniscus. The lateral meniscus covers a larger portion of the articular surface and is also more mobile than the medial meniscus. The medial meniscus is relatively immobile and is attached to the MCL.

Read 16 tweets
Aug 4, 2020
Septic arthritis: a review

Septic arthritis is generally monoarticular and involves either the knee or hip. The hip is more commonly affected in children whereas the knee is in adults. Early intervention is imperative for preserving the affected joint.

Risk factors include age > 80, DM, RA/OA/Gout, HIV, unprotected sex, IV drug abuse, and joint replacement. Presenting symptoms may include fever (60%), pain, swelling, warmth, and erythema of the joint.

Read 11 tweets
Jul 6, 2020
Where art thou osteoclasts?
A review of osteopetrosis.

1/12 Image
Osteopetrosis is a disease that results from defective osteoclast function. Failed bone resorption leads to dense bone that may cause fracture, bone marrow encroachment, or skull foramen narrowing.

3/12 Osteoclasts derive from which of the following precursor cells?
Read 15 tweets

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