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What is a metacarpal fracture?

A metacarpal fracture refers to a break or fracture in one of the metacarpal bones of the hand. The metacarpals are the long bones in the palm of the hand, located between the bones of the fingers (phalanges) and the bones of the wrist (carpals). There are five metacarpal bones in each hand, and they are numbered from the thumb (first metacarpal) to the little finger (fifth metacarpal).

The most commonly fractured metacarpal is the fifth metacarpal. This is also known as a Boxer’s fracture, where there is a break of the fifth metacarpal head or neck.

Metacarpal Fractures
Metacarpal Fractures

How do metacarpal fractures occur?

Some common causes include:

  • Direct Trauma: A direct blow to the hand, such as from a fall, a sports injury, or an accident, can lead to a metacarpal fracture. It can also occur through punching, which often leads to a Boxer’s fracture.
  • Crushing Injuries: Accidents involving a crush or compression of the hand can cause metacarpal fractures. This may occur in industrial or machinery accidents or other situations where the hand is caught between objects.
  • Falls: Landing on an outstretched hand during a fall can transmit a significant force to the metacarpal bones, leading to fractures.
  • Sports Injuries: High-impact sports, such as football or martial arts, can result in metacarpal fractures, particularly if the hand sustains a forceful impact or is involved in a direct collision.

Signs and symptoms of metacarpal fractures

  • Pain: Pain is a primary symptom of a metacarpal fracture. The intensity of pain can vary, and it is often exacerbated by movement or pressure on the hand.
  • Swelling: Swelling around the injured area is a common response to trauma. The swelling may be noticeable immediately after the injury or may develop over time.
  • Bruising: Blood vessels can be damaged during a fracture, leading to bruising (discolouration) around the affected area.
  • Deformity or Misalignment: In some cases, a metacarpal fracture can result in a visible deformity or misalignment of the hand or fingers. You may see rotation of the injured finger such as crossing on top or underneath another finger.
  • Difficulty Moving the Hand or Fingers: Due to pain and swelling, there may be difficulty moving the hand or fingers.
Metacarpal Fractures
Metacarpal Fractures

Treatment options

The treatment of a metacarpal fracture depends on several factors, including the location and type of fracture, the degree of displacement, and the overall health of the individual. Treatment options may include:

  • Immobilisation: For less severe fractures, the affected hand may be treated with a splint to allow the bones to heal properly.
  • Reduction: If the fracture involves a significant displacement of the bones, a Doctor may perform a manual reduction. This involves manipulating the broken bones back into their proper position. This may be done in an emergency setting or during a surgery.
  • Surgery: Surgical intervention may be necessary for complex fractures, fractures with significant displacement, or fractures that involve multiple metacarpal bones.
  • Hand Physio: A Hand Physio will help to improve finger movement, strength and use of the hand.

How a Sydney Hand Clinic can help

A Hand Physio will assess your hand to determine your management. They can also refer you for an X-ray to assess if you need to see a Hand Surgeon.

It’s important for individuals with a metacarpal fracture to follow their Hand Physio or Hand Surgeon’s recommendations. Ignoring or neglecting proper treatment can lead to complications, such as malunion (improper healing), nonunion (failure of the bones to heal), or ongoing pain.

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