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

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.

Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD