Are lateral X-rays useful in the treatment of fractures of the fourth and fifth metacarpals?

During initial and follow-up evaluation of fractures of the fourth or fifth metacarpal, X-rays in PA and oblique pronated views are taken. Routine straight lateral X-rays are also often made in the expectation that they will reveal additional information. The additional value was evaluated of 408 lateral X-rays taken of fourth and fifth metacarpal fractures in 160 conservatively treated patients. No clinically relevant information would have been missed if lateral X-rays had been made selectively. Routine X-rays during treatment of these fractures should initially be limited to PA and oblique pronated views. Only after confirmation of a proximal comminuted fracture or signs of a pronounced anteroposterior dislocation, is an additional lateral X-ray indicated.