Clinical and Radiographic Diagnosis of Coronal Shear Fractures of the Metacarpal Head in Adolescents: A Case Series.
Darryl Ee Ming Chew, Tomasz Jakub Merta, Dawn Sinn Yii Chia
✦ AI-curated · Sources linked
Case in brief
Four adolescent patients presented with intra-articular coronal shear fractures of the metacarpal head, often overlooked due to the fracture plane's alignment with standard radiographic views. A consistent injury pattern involved axial loading on a hyperextended metacarpophalangeal joint, with some patients exhibiting a mechanical click during hyperextension. Initial radiographs were often subtle, but CT imaging clarified the fracture morphology, leading to operative treatment in cases of intra-articular incongruity.
What made this case unusual
The presence of a reproducible mechanical click during terminal hyperextension was noted in two patients, which is an atypical clinical finding associated with this type of fracture.
Diagnostic / clinical pearl
Clinicians should be vigilant for subtle radiographic signs, such as metacarpal head squaring and the double shadow sign, to identify coronal shear fractures early.
Why it matters
Delayed recognition of these fractures can lead to complications such as symptomatic malunion, highlighting the importance of advanced imaging when initial radiographs are inconclusive.