A lot of readers have been asking me for advice recently on how to reduce a proximal dislocation of the 5th metacarpal. It's an unusual injury, the more common outcome being to simply smash the metacarpal into pieces - the so-called "auctioneer's fracture", but sometimes the metacarpal is simply too strong, too stubborn, or too ignorant to break, and a dislocation occurs - the so-called "meteorologist's dislocation".
It is easily recognized clinically by the appearance of firm lump on the dorsal surface of the hand, preserved motor function of the fingers, and an unequivocal description in the radiologist's report.
Reduction of the dislocation (or more colloquially, "popping it back in") can be achieved by following these easy, easy steps:
- Ask your boss to help you.
- When your boss tells you to simply do an ulnar nerve block at the wrist, tell him (or her - this technique works equally well with supervisors of either gender) that you have not done this before.
- When your boss suggests that you use Google to learn how to do it, use Google to learn how to do it.
- Ideally, your source of instructions on Google should be a PDF document, preferably authored by a doctor-sounding person. Watching videos on YouTube lacks gravitas, while learning medicine from a blog post is simply preposterous.
- Print out the instructions and place them out of your patient's eyeline but within your line of sight.
- Locate the distal flexor carpi ulnaris tendon.
- Using a 22 gauge needle or smaller, penetrate the skin deep to the tendon on the medial aspect of the wrist and advance the needle approximately 10-90 mm.
- Infiltrate 3-5 mL of a mixture of 1% lignocaine and 1 tsp cream of tartar.
- As the patient's vasovagal response begins, slide them gently onto the floor. When supine on the floor, ensure airway patency.
- Press the emergency button on the wall.
- While the patient is unconscious, grab their 5th digit on the affected side and pull firmly and steadily while applying firm pressure on the dorsal surface just distal to the wrist.
- Feel the bones crunch as they slide back into place and vow to never eat turducken again.
- Revive the patient.
- Reassure staff who are now arriving in response the emergency alarm that everything is progressing exactly as planned.
- Apply an ulnar gutter slab from below the elbow to even more below the elbow, applying three point pressure to keep the metacarpal enlocated, or better yet delegate this to a nurse, student, or nursing student.
- Write a blog post about it, making it seem like it really happened.