Metacarpal Fracture

The metacarpal bones are in the middle of the hand, connecting the fingers to the wrist. A metacarpal fracture is a break in one of these bones. It is common for an injury of the hand to break one or more of these bones. A metacarpal fracture of the fifth (little) finger, near the knuckle, is also known as a boxer's fracture.

SYMPTOMS

  • Severe pain at the time of injury.

  • Pain, tenderness, swelling (especially the back of the hand).

  • Bruising of the hand within 48 hours.

  • Visible deformity, if the fracture out of alignment (displaced).

  • Numbness or paralysis from swelling in the hand, causing pressure on the blood vessels or nerves (uncommon).

CAUSES

  • Direct hit (trauma) to the hand, such as a striking blow with the fist.

  • Indirect stress to the hand, such as twisting or violent muscle contraction (uncommon).

RISK INCREASES WITH:

  • Contact sports (football, rugby, soccer).

  • Sports that require hitting (boxing, martial arts).

  • History of bone or joint disease, including osteoporosis.

  • Poor hand strength and flexibility.

PREVENTION

  • Maintain proper conditioning:

  • Hand and finger strength.

  • Flexibility and endurance.

  • For contact sports, wear properly fitted and padded protective equipment for the hand.

  • Learn and use proper technique when hitting, punching, and landing from a fall.

PROGNOSIS

If treated properly, metacarpal fractures can be expected to heal within 4 to 6 weeks. For severe injuries, surgery may be needed.

RELATED COMPLICATIONS

  • Fracture does not heal (nonunion).

  • Heals in a poor position, including twisted fingers (malunion).

  • Chronic pain, stiffness, or swelling of the hand.

  • Excessive bleeding in the hand, causing pressure and injury to nerves and blood vessels (rare).

  • Unstable or arthritic joint, following repeated injury or delayed treatment.

  • Hindrance of normal hand growth in children.

  • Infection in open fractures (skin broken over fracture) or at the incision or pin sites, if surgery was performed.

  • Shortening or injured bones.

  • Bony bump (spur) or loss of shape of the knuckles.

TREATMENT

Treatment will vary, depending on the extent of the injury. First, ice and medicine will help reduce pain and inflammation. For a single metacarpal fracture that is not displaced and does not involve the joint, restraint is usually sufficient for healing to occur. Multiple metacarpal fractures, fractures that are displaced, or fractures involving the joint may require surgery. Surgery often involves placing pins and screws in the bones, to hold them in place. Restraint of the injury follows surgery, to allow for healing. After restraint (with or without surgery), stretching and strengthening exercises may be needed to regain strength and a full range of motion. Exercises may be done at home or with a therapist. Sometimes, depending on the sport and position, a brace or splint may be needed when first returning to sports.

MEDICATION

  • Do not take pain medicine for 7 days before surgery.

  • Only take over-the-counter or prescription medicines for pain, fever, or discomfort as directed by your caregiver.

  • Prescription pain medicines are usually prescribed only after surgery. Use only as directed and only as much as you need.

COLD THERAPY

Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse even with treatment.

  • You have pain, numbness, or coldness in the hand.

  • Blue, gray, or dark color appears in the fingernails.

  • Any of the following occur after surgery:

  • You have an oral temperature above 102° F (38.9° C), not controlled by medicine.

  • You have increased pain, swelling, redness, drainage of fluids, or bleeding in the affected area.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)