Most important fracture in this category is fracture dislocation of the base of the thumb metacarpal known as Bennettes fracture. Once fractured, the larger metacarpal shaft fragment is dislocated by the opposing pull of adductor and abductor of the thumb.

Management

Consists of either closed reduction and immobilisation with a well padded thumb spica cast or closed reduction and K wire fixation under image intensifier control and plaster immobilisation, this is a preferred method to prevent redislocation of the fragments due to muscular forces.

Complications

Improper treatment leads to malunion with adducted thumb and carpo metacarpal arthrosis.

Fracture of the Neck of 5th Metacarpal

An innocuous looking injury, usually sustained in fist fight, results in volar flexion of the head fragment, leading to inability to extend the little finger. Treatment in acute case consists of closed manipulative reduction and immobilisation in a ball and bandage. If already malunited, it would require open reduction and internal fixation.