A Fractured Metacarpal: What You Need to Know

A metacarpal fracture is a common injury of the hand that involves one or more of the five metacarpal bones that run from the wrist (carpal) bones to the knuckles. An impact injury, such as a fall or blow to the hand, is usually the cause.

Treatment typically involves immobilization, pain relief, and rehabilitation, although surgery may be needed in severe cases. Metacarpal fractures can take more than a month to heal.

The article looks at the symptoms and causes of metacarpal fractures and explains how these common fractures are diagnosed and treated.

Metacarpal Fracture Symptoms

Symptoms of a metacarpal fracture include:

• Severe pain that worsens when gripping or balling your hand into a fist
• Swelling
• Tenderness
• Bruising
• Stiffness or inability to move a finger
• Numbness in your hand or fingers
• A visible deformity, such as a visible lump or misaligned bone
  

There is a metacarpal bone in each of your 10 fingers, and any of them can be fractured. Symptoms of a fractured metacarpal are restricted to the finger that has the break.

Causes of Metacarpal Fracture

Metacarpal fractures are commonly caused by an impact injury in which something either strikes the hand or the hand strikes something with great force.

Common causes of a metacarpal fracture include:

• Hitting your hand on the ground while falling
• Sports injuries from sports like football, basketball, hockey, boxing, and soccer
• Getting your hand slammed in a door
• Car accidents
• Fist fights or punches
  

Diagnosis

Some metacarpal fractures can be diagnosed with a physical exam, especially compound fractures in which there is an open wound or break in the skin near the site of the broken bone.

An X-ray is standardly used to diagnose and characterize the nature of the fracture.

Metacarpal fractures are generally described by the location of the fracture:

• Metacarpal shaft fracture: Fracture in the center of the bone
• Metacarpal head fracture: Fracture by the base of the finger at the knuckle
• Fractures of the base of the metacarpal: Fracture near the wrist bones

The location of the actual fracture is important in determining the best treatment for the injury.

Fractured Metacarpal Treatment

Metacarpal fracture almost invariably requires extended immobilization, either in the form of a splint or a cast. The immobilization of the hand can take anywhere from three to six weeks, depending on the severity of the break.

Because a metacarpal fracture can be extremely painful, your healthcare may recommend the following remedies to better manage pain:

• Ice application and elevation of the hand during the early stages
• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) for temporary, short-term pain relief
• Prescription opioid drugs like codeine for short-term relief of severe pain

Rehabilitation

After ample healing has been achieved, a rehabilitation plan with a physical therapist may be recommended.

This is to prevent complications like osteoarthritis ("wear-and-tear" arthritis), nerve or blood vessel damage, or permanent stiffness, pain, or loss of hand mobility.

Surgery

There are a few situations where surgery may be recommended, including:

• When there is a compound (open) fracture
• When a bone fragment is loose and could heal unevenly
• When a bone piece moves before it heals correctly
• When a bone causes a finger to rotate abnormally
• When a fracture might cause a finger to get shorter
• When ligaments, blood vessels, or nerves have been damaged
• When a fracture extends to a joint or the carpal bones

If surgery is needed, the surgeon may fix the broken bone with pins, plates, or screws.

In severe cases, such as crush injuries, external fixation may be needed. With this, external hardware is attached to the bone fragments to hold them in place.