Second Metacarpal First Web

When examining an acute laceration of the first web for signs of index metacarpal bone injury, the goal is to determine if the laceration did not touch the bone, hit the bone but did not injure it, or hit the bone and caused an open (compound) fracture.

The initial step in examining a bone is to inspect the bone for signs of deformity, angulation, tenderness, or exposure of the bone allowing it to be observed in the depths of the laceration.

Next evaluate the index metacarpal bone of the first web for tenderness that is not related to the laceration alone. This can be done by gently palpating the index metacarpal bone. To palpate for bony tenderness the examiner should palpate the index metacarpal by applying pressure to the bone without simultaneously palpating the laceration. With an extensive laceration this may not be possible. With severe lacerations the increased pain caused by even gentle palpation of the skeletal structures may make palpation of the bones impossible.

While palpating for tenderness the examiner should also assess the individual bones for signs of crepitus. Crepitus, the Latin word for rattling or creaking at the site of injury, can be detected when fractures were manipulated gently. A fracture that can demonstrate crepitus may be unstable enough that false motion is detected in an area of the bone where there is no joint.

Definition of a Positive Result

A positive (abnormal) result occurs when the examiner observes fracture tenderness, fracture crepitus, false motion at a potential fracture site, gross limb deformity or mechanical blocks to flexion or extension while examining potentially injured parts of the skeleton.

Definition of a Negative Result

A negative (normal) result occurs when the examiner no fracture tenderness, no fracture crepitus, no false motion at a potential fracture site, no gross limb deformity and normal joint flexion or extension while examining potentially injured parts of the skeleton.