Metacarpal fractures

Also known as Boxer’s fractures.

Who does it affect and why does it occur?

Metacarpal fractures often occur in males. 

A punching type injury is the most common cause of a metacarpal fracture. This may either occur with the hand striking another object or the hand falling from a height and, in effect, punching the floor or solid object.

Patients notice immediate pain on the back of the hand, and there may be clinical deformity.
Clinical examination
The doctor will carefully ask the patient to bend and straighten the fingers to ensure they are aligned and do not twist on flexing. In addition to this, the doctor will assess that the tendons both on the front and the back of the finger have not been injured during the accident. 

Special features of this condition
The vast majority of metacarpal fractures can be treated non-operatively with early mobilization. The little finger metacarpal is the most common, and this can accept a significant degree of angulation without functional problems. However, the index and middle finger metacarpals can tolerate less angular deformity and often require fixation. This photograph shows an index metacarpal fracture that is displaced and is causing significant rotatory deformity. It will require fixation in an anatomical position with surgery.

Plain x-rays are the mainstay of evaluating metacarpal fractures. 

Non-operative treatment
The vast majority of metacarpal fractures occur in the little finger and require no operative treatment. Early mobilization is the key to a successful outcome.

Operative treatment
This is usually reserved for severely angulated fractures and also fractures involving multiple metacarpals. Fractures involved in the index and middle finger have an increased likelihood of requiring internal fixation due to the inability to tolerate angular deformity on this side of the hand. Operative treatment can include plates, screws and buried wires.

Post-operative rehabilitation
Early mobilization of the hand aids healing and prevents tendons from sticking to the underlying bone.

Complications of Hand Fractures

Because some fractures require prolonged immobilization in a cast or splint, your hand and fingers may become stiff. Your doctor or, in some cases, an occupational therapist, physical therapist or hand therapist will provide specific exercises to help decrease stiffness and improve function.
Even after carefully following therapy instructions after fracture treatment, some patients may continue to have difficulty with stiffness or a contracture (loss of motion) in the hand. If this occurs, your doctor may recommend a surgical procedure to help restore motion and/or function to your finger. Commonly used procedures include:
⦁ Surgical removal of the retained hardware (such as pins, screws, or plate and screws)
⦁ Tenolysis—freeing up a tendon from scar tissue.
⦁ Contracture release—releasing the tight or restrictive supporting structures around the involved joint, including the ligaments and/or joint capsule
Generally, these procedures are used once a fracture has healed and there is no evidence of progress or improvement in the return of the function to the injured finger. Your doctor will talk with you about whether an additional procedure is needed in your situation and how it may affect your recovery. 

Finger Fractures 

Although the bones in the hand are small, a broken (fractured) finger is not a minor injury. The bones in a normal hand line up precisely. They let you perform many specialized functions, such as grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can cause your whole hand to be out of alignment. Without treatment, your broken finger might stay stiff and painful.


Your hand consists of 27 bones: eight bones in your wrist (carpals), five bones in the palm of your hand (metacarpals), and 14 bones in your fingers (phalanges). Fractures of the metacarpal bone that leads to the little finger account for about one-third of all hand fractures in adults.


Generally, a fractured finger occurs as the result of an injury to the hand. You can fracture a finger when you slam your fingers in a door, when you put out your hand to break a fall, or when your finger jams while trying to catch a ball. Carelessness when working with power saws, drills, and other tools can result in a fractured finger.


⦁ Swelling of the fracture site
⦁ Tenderness at the fracture site
⦁ Bruising at the fracture site
⦁ Inability to move the injured finger in completely
⦁ Deformity of the injured finger

Doctor Examination

If you think you fractured your finger, immediately tell your doctor exactly what happened and when it happened. Your doctor must determine not only which bone you fractured but also how the bone broke. Bones can break in several ways: straight across the bone, in a spiral, into several pieces, or shatter completely.
Your doctor may want to see how your fingers line up when you extend your hand or make a fist. Does any finger overlap its neighbour? Does the injured finger angle in the wrong direction? Does the injured finger look too short? Your doctor may x-ray both of your hands to compare the injured finger to the uninjured finger on your other hand.


Nonsurgical Treatment
Your doctor will put your broken bone back into place, usually without surgery. You will get a splint or cast to hold your finger straight and protect it from further injury while it heals. Sometimes your doctor may splint the fingers next to the fractured one to provide additional support. Your doctor will tell you how long to wear the splint. Usually a splint on a fractured finger is worn for about 3 weeks. You may need more x-rays over this time so that your doctor can monitor the progress of your finger as it heals.
Surgical Treatment
Depending on the type and severity of the fracture, you may need surgery to put the bones into alignment. Small devices, such as pins, screws, or wire, will be used to hold your fractured bones together.
You may begin using your hand again as soon as your doctor determines it is okay to move your finger. Doing simple rehabilitation exercises each day will help reduce the finger’s stiffness and swelling. You may be required to see a physical therapist to assist you in these exercises.

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