Avulsion Fractures at the Base of the 2(nd) Metacarpal Due to the Extensor Carpi Radialis Longus Tendon: A Case Report and Review of the Literature

INTRODUCTION: Simultaneous contraction of the extensor carpi radialis longus (ECRL) with forced hyperflexion of the wrist can result in avulsion of the tendon and its bony attachment at its insertion at the dorsum of the base of the second metacarpal. This is a rare and often unreported fracture pattern. CASE PRESENTATION: We present a 31- year- old male who sustained a hyperflexion injury. He was managed surgically and had good post-operative outcomes. A literature search revealed 16 papers covering 18 cases of similar injuries. 12 were initially managed surgically and 6 were managed conservatively. CONCLUSIONS: Of the open reductions and internal fixations, 11 (92%) were successful and patients made a full recovery. Conservative management was unsuccessful in 4 cases; one patient required surgery for metacarpal boss, one patient had retraction of the tendon at one week follow up and another had weak flexion of the wrist. We recommend open reduction and internal fixation for these injuries. It may allow a faster recovery and therefore allow an earlier return to work and activity.