20250805 Hand Fractures P2 Dr Rashdeep

A 24-year-old man punches a wall in anger. On examination, he has pain and swelling over his right hand, with mild angulation of the fifth metacarpal neck but no rotational deformity. What is the most appropriate initial management?

• A. Closed reduction and splinting

• B. Open reduction and internal fixation

• C. Buddy taping and early mobilisation

• D. Immediate surgical intervention

Answer explanation

Most simple impacted fifth metacarpal neck fractures without rotational deformity can be managed conservatively with buddy taping and early motion.

A 32-year-old carpenter presents with a displaced third metacarpal shaft fracture and scissoring of the fingers on making a fist (rotational deformity). What is the best next step in management?

• A. Buddy taping

• B. Functional bracing

• C. Open reduction and internal fixation

• D. Cast immobilization without manipulation

Answer explanation

Rotational deformity is a surgical indication for metacarpal shaft fractures, especially when it leads to finger overlap.

A 20-year-old male presents to the emergency department after a sports injury with swelling and pain over his right hand. On exam, you note dorsal hand bruising and tenderness at the base of the second metacarpal. What imaging investigation is most appropriate?

• A. CT scan

• B. Hand ultrasound

• C. Plain radiographs (X-ray)

• D. MRI of the hand

Answer explanation

The first-line investigation for a suspected metacarpal fracture is plain film radiographs of the hand.

What degree of apex dorsal angulation is generally acceptable for a small finger metacarpal neck fracture without functional impairment?

•    A. Up to 15 degrees

• B. Up to 30 degrees

•   C. Up to 50 degrees

• D. Up to 70 degrees

Which of the following is the most common long-term complication following plate fixation of metacarpal fractures?

• A. Tendon rupture

• B. Nonunion

• C. Stiffness and limited range of motion

• D. Deep infection

Answer explanation

Stiffness is the most commonly reported complication after plate fixation of metacarpal fractures, more so than nonunion or infection.