Extracapsular extrusion of a horizontal metacarpal head fracture.

E10 J can chir, Vol. 52, N 1, février 2009 © 2009 Association médicale canadienne I ntra-articular fractures of the metacarpal head are rare, often requiring surgical fixation to maintain articular congruence. McElfresh and Dobyns presented a 10-group classification of 103 such fractures based on anatomic involvement and fracture pattern (Table 1). They identified only 4 with a horizontal fracture pattern. On a further review of the literature, Hastings and Carroll identified 4 additional cases with this pattern. Surgical management, long-term outcome and the possibility of extrusion of the metacarpophalangeal joint capsule were not described. We report the unusual case of a horizontal fracture of the metacarpal head, complicated by 90° dorsal rotation about a transverse axis, and extrusion of the head fragment from the joint capsule. We describe our approach to assessment, surgical management and successful restoration of function.