Intra-articular metacarpal head fractures

One hundred and three intra-articular metacarpal head fractures in 100 patients are presented and classified by anatomical involvement on roentgenographic examination. The fractures were epiphyseal (Salter-Harris type III, n = 4), ligament avulsions from metacarpal head (n = 17), osteochondral (n = 8), oblique (sagittal, n = 22), vertical (coronal, n = 4), horizontal (transverse, n = 4), comminuted (n = 31), boxer's fractures with extension into the joint (n = 3), loss of substance (n = 6), and occult compression with avascular necrosis (n = 4). Experience with fractures involving large intra-articular defects suggests that they should be reconstructed to give a congruous metacarpal head; the digit should then be mobilized as early as technically feasible.