![]() ![]() 4, 7 Niechajev 2 performed a retrospective review of 23 fractures, treated either by closed reduction and percutaneous pinning or open reduction and internal fixation. Internal fixation to restore articular congruity is recommended by some authors, 1, 2 whereas others advocate cast immobilization 4, 6 or early unrestricted mobilization. The authors have recommended a variety of treatment options. Since then, multiple case reports and series have been published, but the optimal treatment of these fractures remains uncertain. Clement 5 first described an isolated intra-articular fracture of the base of the fifth metacarpal. In contrast, the treatment of isolated intra-articular fractures of the base of the fifth metacarpal remains controversial. 4įractures of the first metacarpal base have been well described, and reliable methods of treatment have been established. The radial fragment at the base of the fifth metacarpal is held in place by the interosseous metacarpal ligament, which connects the fourth and fifth metacarpals bases. ![]() Instability of intra-articular fractures of the fifth metacarpal base is mainly due to the strong, unopposed proximal pull of the extensor carpi ulnaris, which causes ulnar and dorsal subluxation of the main fracture fragment. 2, 4 Force acting on the head of the metacarpal causes a metacarpal neck fracture, but in some cases metacarpal base fracture occurs. Striking a hard object with a closed fist was the most common cause of an intra-articular fracture of the base of the fifth metacarpal. 1, 3 Hence they are sometimes referred to as “Mirrored” Bennett's and Rolando's Fractures. Intra-articular fractures of the fifth metacarpal resemble Bennett's and Rolando's fractures in their pattern 1, 2 and their tendency to be unstable. This is an intra-articular fracture of the fifth metacarpal. ![]()
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