Background: There are many methods for evaluating a traumatized metacarp. Objectives: This study sought to evaluate the accuracy of the metacarpal compression test for the diagnosis of metacarpal fracture. Methods: All patients with metacarpal trauma were tested via placement of axial load (compression) on the metacarpal; induction or exacerbation of pain on each metacarp was recorded upon applying axial pressure. Then, an X-Ray imaging system was used to identify and record the presence of fracture. All data were entered into a 2x2 table, and then negative predictive value (NPV), positive predictive value (PPV), sensitivity and specificity of the test were calculated. Results: After careful physical examination and application of the axial pressure on the metacarpal bone, 16(23. 68%) patients did not experience any pain during axial loading (none had fracture). According to the statistical analyses of the data, the proposed method had a 69% specificity, 100% sensitivity, 86% PPV and 100% NPV. Conclusion: Our findings showed that axial loading applied on the metacarpal bone, when it leads to pain, is a good marker for fracture. On the other hand, patients with negative test results had no fracture on radiography, which emphasized 100% NPV of the test.

A 20-year-old Iranian male after injury in a football match with pain in the finger was referred to the hospital. X-Ray images of his hand showed no fractures, but the shortening of third to fifth metacarpal bones was clearly observed. The short metacarpal bone is a very helpful diagnostic marker in the patients suffering from idiopathic hypoparathyroidism (IHP), pseudohypoparathyroidism type Ia (PHP-Ia) with Albright’ s hereditary osteodystrophy (AHO) phenotype, pseudopseudohypoparathyroidism (PPHP), and brachydactyly type E. Briefly, in hypoparathyroidism disease, the serum calcium level decreases and the serum phosphorus level increases in blood. PHP-Ia disorder is clinically similar to hypoparathyroidism; in this disease, the level of parathyroid hormone is normal but there is resistance to it. PPHP disease is not an endocrine disorder but is related to PHP-Ia. In this disease, serum levels of calcium and phosphorus are normal, also symptoms and signs in PPHP are similar to PHP-Ia, but there is no resistance to parathyroid hormone. In brachydactyly type E, shortening of metacarpal or metatarsal bones is caused by abnormal development of phalanxes, metacarpals, or both. His laboratory tests revealed a low serum calcium level, high serum phosphate level, and low serum PTH level; therefore a diagnosis of IHP was reached.

Complete dorsal MCP dislocation of fingers can be simple or complex. Simple dislocations can be reduced nonoperatively but close reduction of complex MCP dislocations often is not possible and needs surgical intervention and the choice of surgical approach is based on surgeon s preference.In this report two patients have came with dorsal MCP dislocation of index and metaphyseal fracture of third metacarpal with MCP dislocation who were not diagnosed earlier in their first visit.

Background: Trauma to the hand is very common and consequently, metacarpal fractures are not rare entities. Some of these fractures need surgery. Considering the diversity of surgical methods available for these kinds of fractures and also the importance of achieving full function and speedy return to work for patients that are mainly young workers or athletes, this study was undertaken to investigate the outcome of treating these fractures by mini-plates.Methods: Eighteen patients with open or comminuted fractures of metacarpal bones who were admitted to the emergency department of Sina Hospital between the years 2007and 2010 underwent fixation surgery using mini-plates. Fourteen patients with 17 metacarpal fractures completed the study.Results: Thirteen out of 14 patients had complete fracture union. The patient with nonunion underwent revision surgery and bone graft. Four individuals developed an extensor lag of 15 degrees without functional impairment. Two patients had joint stiffness that was relieved after a period of physiotherapy and one developed wound dehiscence and discharge that improved with debridement and use of antibiotics without plate removal. Six patients had complaints regarding their hardware prominence and were satisfied after its removal. Overall, there was a79% satisfaction rate upon the treatment.Conclusion: Despite the afore-mentioned complications, use of mini-plates seems to be a suitable treatment option for patients with comminuted metacarpal fractures.However, more studies with larger sample sizes are suggested to reach a firm conclusion.

Background: The incidence of firearm related non-fatal and fatal accidents has been increased worldwide. Most of the unintentional or intentional nonfatal gunshot injuries involve an extremity.Case Report: A 33-year-old man was admitted to emergency department with a complaint of injury related to 5th metacarpal area of right hand. The patient reported that he is a police officer who suffered gunshot injury during crashes with smugglers in himself right hand. At arriving time into hospital, hand was neurologically intact and no vascular injury was noted. There was a distractive entrance wound in the 5th metacarpal hypothenar palmar area and a distractive exit wound on the dorsal side. The wound was irrigated and debrided. All lose bone fragments were removed. The lose area covered by distant flap of skin from the abdomen. All of the wounds were healed on postoperative 15th day.Conclusion: This report is an attempt to present the problem of firearm injury and appeal to a wide range of disciplines working to expand their knowledge and redirect new energy to address the urgent problem of firearm injury.

Background: Fracture of metacarpal and phalangeal bones of hand are common sport and industrial injuries in the upper extremity. Mini-plate fixation is one of the techniques used in fixation of unstable kind of fractures in hand. We would like to report our experience with such fractures treated with titanium mini-plates.Methods: In a clinical trial study, 29 patients with 48 unstable hand fractures (21 metacarpal, 27 phalanges) received titanium mini-plate fixation during 1999-2006. The mean age was 27 years (14-53). Twenty eight cases were periarticualr and 20 shaft fractures. The cases were evaluated with an average follow-up of 17 months (6-52), and range of motion and function were assessed.Results: The results, based on total active motion, were considered excellent in 39 (³221 degrees), good in 8 (121-220 degrees) and poor in 1 case (<120 degrees).Conclusions: Mini-Plate fixation in unstable metacarpal or phalangeal fractures creates secure fixation and good alignment for early joint motion in hand.

Introduction: Metacarpal fractures are common in childhood and adolescence and bone healing is the rule. Case Presentation: We present a two-year-old boy with an established nonunion of the fourth and fifth metacarpal fractures, treated successfully without any complications. Both fractures resulted from a high-energy trauma; although initial treatment seemed appropriate, nonunion occurred. The child was referred to our center for nonunion and humpback deformity. The patient was treated with open reduction/internal fixation and bone graft. All metacarpal fractures healed radiographically and clinically without any problem. The final functional and cosmetic result was excellent. Conclusions: Although the occurrence of metacarpal nonunion is rare in children, careful follow-up must be done to achieve osseous union finally.