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Metacarpal Fractures

What is a metacarpal fracture?

A metacarpal fracture is a specific term for a type of hand fracture. This is the most common fracture of the hand. The fracture can be simple with just two fragments or may shatter into many pieces (“comminuted”). Most fractures are “closed” (no break in the skin), but they can also be “open” (a break in the skin). Fractures may be even more complex if they involve the major joints of the hand or wrist (an “intra-articular” fracture). Fractures may occur as part of a more complex injury where there has been damage to other tissues such as tendons, nerves and blood vessels.

What may indicate a metacarpal fracture?

A metacarpal fracture is almost always the result of some type of trauma, most commonly a direct impact to the hand. Weak bones (like those with osteoporosis) will break more easily.

When the hand is broken, there is usually a great deal of pain and swelling. This pain and swelling can make it hard to move or use the hand and wrist, but some people can still move or use the hand or wrist even if there is a broken bone. The hand or fingers may appear deformed because the bones are out of place.  

How is a metacarpal fracture diagnosed?

The diagnosis of a metacarpal fracture is made by reviewing your medical history, a physical examination, and X-rays. Additional tests, such as a CT scan, may be required to get high level detail of the fracture and fracture fragments to determine the type of treatment that is necessary.

How is a metacarpal fracture treated?

Generally speaking, the treatment will be guided by a few main factors:

  1. How “bad” the fracture is – whether it is displaced, unstable, or open.
  2. The “you” factors – your age, hobbies, functional demands, activities, your health, and what you do for work

If you suffer a “displaced” metacarpal fracture, the first step may be to “reduce” or “set” the fracture. This may be done in the ER by an ER physician, or by one of our hand surgery specialists.  If the fracture is stable, a cast may be used to hold a fracture that has been set. In some instances, the fingers and hand may undergo “early range of motion” even while the fracture is healing to help prevent stiffness and loss of motion. Other fractures may benefit from surgery to put the broken bones back together and hold them in correct place. In some cases, a well performed operation can get you back to your normal activities faster and with better results than if you have a cast alone.

Are there special ways to treat metacarpal fractures to get better results?

Historically, metacarpal fractures that needed surgery were treated with “pins” also known as “K-wires.” This required the surgeon to reset the bone in the operating room and hold the bones together with these pins. Unfortunately, this form of holding the bones together is not “rigid” and therefore, patients required a cast after surgery. This often led to good bone healing, but poor motion in the post-operative setting, even with months of therapy.

There have been numerous advances in treating hand fractures with new forms of “rigid fixation” that allow not only excellent rates of bone healing, but also allow for much earlier range of motion by taking advantage of the rigidity of the fixation constructs. Since patients can start therapy much earlier in these scenarios, the post-operative motion is much improved with an earlier return to work and activity.

Our hand surgery specialist will let you know upon review of your situation and x-rays whether or not you are a candidate for these newer methods of fixation.

Will I need therapy following metacarpal fracture treatment?

Regardless of whether the fracture is fixed or not, you will most likely require some hand therapy to get the motion of your hand and fingers back. The timing and duration of therapy will depend on whether or not you have surgery and how stable your fracture is. Hand therapy is very helpful to recover motion, strength and function.