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Differential Diagnosis
- Hand sprain
- 4th Metacarpal (barber pole) fracture
- 5th Metacarpal (boxer’s) fracture
- Ulnar styloid avulsion fracture
![](https://www.jucm.com/wp-content/uploads/2024/08/09.2024-JUCM-Images-Xray-2.jpg)
Diagnosis
This is a 4th metacarpal shaft fracture, specifically a “barber pole” fracture. Findings on the AP x-ray reveal a spiral band of sclerosis that has the appearance of a barber pole as well as a displaced spiral fracture of the 4th metacarpal on the oblique view. This type of barber pole fracture is common and may involve fractures of the metacarpal head, neck, and/or shaft. The mechanism of injury for a shaft fracture includes axial loading or direct trauma (eg, clenched fist and solid surface impact). Rotational and/or torsional force may also result in this type of injury.
What to Look For
- Metacarpal fractures are most often the result of direct trauma but may also occur from repetitive stress
- Locations metacarpal fractures include the head, neck, shaft and base of the metacarpal
- Key examination components include evaluation for bony deformity, malrotation, skin breakage and neurovascular compromise
Pearls for Urgent Care Management
- Metacarpal fractures with significant angulation first require reduction
- Treatment includes gutter splint immobilization for nondisplaced metacarpal fractures with minimal angulation and no malrotation; immobilize metacarpophalangeal joints in 70-90° of flexion and splint for at least 4 weeks
- Referral to orthopedics is indicated for open fractures, unacceptable angulation, malrotation, and multiple fractures for consideration of operative management
Download the article PDF: 47-Year-Old With Right Hand Pain, 4th Metacarpal Shaft Fracture
47-Year-Old With Right Hand Pain
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