PV card: Metacarpal fractures

$metacarpal fracture rotationa angulationa=$ Patients with rotation deformities of the fingers from a metacarpal fracture should be reduced. All fingers should normally point towards the patient’s scaphoid bone.

Metacarpal (MC) fractures are common injuries, which often spark discussions about whether they should be reduced in the ED urgently.

What are the criteria for acceptable degrees of angulation? Are these criteria different for the MC neck versus shaft?
Which fractures tend to be unstable and thus require eventual operative repair?
How should I splint the injury?

Here’s a quick-reference card to help guide your management decisions. These recommendations may vary slightly based on what references you use. You may need to tailor your decisions based on your regional practices.

PV Card: Metacarpal Fractures

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Go to ALiEM (PV) Cards for more resources.

Thanks to Dr. Nicole Strauss at the UCSF-SFGH Orthopaedic Trauma Institute and my go-to hand expert for her input.

By Michelle Lin, MD|2021-10-08T09:33:03-07:00Dec 13, 2012|ALiEM Cards, Orthopedic|

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Undifferentiated tachycardias, especially when the rate is extremely fast, make it difficult to see anything other than the QRS complexes! Is there a P or flutter wave?
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Teaching internationally: More than just a language barrier

I recently traveled to San Salvador to help teach a pediatric and adult ultrasound course. The course was well received and it was wonderful traveling around San Salvador.

I wanted to share some of our experiences, and discuss some challenges to educating internationally. More importantly, I want to engage you, the readers to share some of your experiences when educating internationally as well.

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Is the 6-12-12 adenosine approach always correct?

The ACLS-recommended dosing strategy of 6 mg, 12 mg, and 12 mg for adenosine may not be appropriate in every situation. There are a few instances when lower or higher dosing should be considered.

Caveat: All recommendations are data-based, but many factors affect successful conversion of paroxysmal supraventricular tachycardia (PSVT) including proper line placement and administration technique.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T18:43:07-08:00Dec 6, 2012|Cardiovascular, Tox & Medications|

Poll: How would manage a metacarpal fracture in the ED?

$Metacarpal5fracture$

I am in the process of creating a PV card on metacarpal fractures, divided into anatomical areas (base, shaft, neck, head), and am realizing that the EM and orthopedic literature don’t quite agree. Actually they are quite vague on whether reductions should occur in the ED vs orthopedics clinic in the next few days.

Do you need to close-reduce all angulated fractures in the ED, which are outside of “acceptable” angulations?
What exactly are “acceptable” angulations? Some sources say that angulations of 10, 20, 30, and 40 degrees are acceptable for MC neck fractures and only 10, 10, 20, and 20 degrees are acceptable for MC shaft fractures. These numbers, though, vary from reference to reference.

(more…)

By Michelle Lin, MD|2016-11-11T18:43:07-08:00Dec 5, 2012|Orthopedic|

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Trick of the Trade: Sterile cover for linear ultrasound probe

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By Michelle Lin, MD|2019-01-28T22:10:44-08:00Nov 27, 2012|Tricks of the Trade, Ultrasound|

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