Metacarpal Fractures

Hand Anatomy

The hand is composed of 3 types of bones – carpals or wrist bones, metacarpals or long hand bones, and phalanges or finger bones. Metacarpals consist of five long bones that connect the carpals with the phalanges. Structurally, metacarpal bones can be divided into four parts: base, shaft, neck, and head.

What are Metacarpal Fractures?

Metacarpal fracture is a condition characterized by the breakage or dislocation of the long hand bones called metacarpals that form the skeleton of the palm. Metacarpal fractures can damage associated soft tissues such as cartilage, ligament, tendons, joint capsule, as well as adjoining nerves.

Causes of Metacarpal Fractures

The common causes involved in metacarpal fractures include:

• Directly falling on the hand
• Trauma or direct impact to the hand
• Punching on a hard object

Symptoms of Metacarpal Fractures

The main symptoms that arise from metacarpal fractures are pain and swelling along with bruising in the inner or outer palm area; Misalignment or deformity may be visible.  Pain may be intense with movement of the hand. Metacarpal fracture can even affect the movement of the fingers.

Diagnosis of Metacarpal Fractures

The diagnosis of metacarpal fracture includes physical examination and X-ray of the hand to confirm the exact location of the fracture. In cases of complex fractures, other imaging techniques such as CT scan and MRI scan may also be necessary.

Treatment of Metacarpal Fractures

Metacarpal fractures need immediate treatment that include proper alignment and casting of the bones to ensure proper healing. In severe cases surgery may be recommended.

Metacarpal fracture or dislocation can be treated non-surgically by aligning the fractured bones and checking the movement of fingers, under local anesthesia. The fractured hand is wrapped with forearm-based splints or a cast to immobilize the bone to promote natural healing. A follow-up X-ray can be taken to confirm the alignment and healing process. Physical therapy is recommended to regain the strength and movement of hand. Complete healing may take 3-4 weeks.

In severe cases, surgery may be recommended and is performed under local or general anesthesia. Surgery includes making an incision over the fracture, followed by alignment and fixation of the fractured bone using plates and screws. After surgery, the incision is sutured and covered with a splint. Healing of the bone may take 6 weeks whereas complete recovery needs a few months.

Post-operative care

Common post-operative instructions to be followed after metacarpal fracture surgery include:

• Get adequate rest and keep your hand above heart level to reduce swelling
• Avoid heavy lifting of objects till the hand is completely healed
• In case of pain and swelling, take the prescribed medications
• Physical therapy is recommended to strengthen and restore hand movements
• Follow the specific instructions given by your doctor

Risks and complications

The possible risks and complications associated with metacarpal fracture surgery include:

• Pain
• Bleeding
• Infection
• Stiffness
• Nonunion (bone fails to unite)
• Malunion (Deformed union of the fractured bone)
• Damage of the surrounding nerves or blood vessels