Metacarpal Fractures

Mr Mike Hayton
FRCS (Trauma and Orth) FFSEM (UK)
Consultant Orthopaedic Hand Surgeon

Other common names

• Boxer's fractures.

Who does it affect?

Metacarpal fractures often occur in males.

Why does it occur?

A punching type injury is the most common cause of a metacarpal fracture. This may either occur with the hand striking another object or the hand falling from a height and, in effect, punching the floor or solid object.

Symptoms

Patients notice immediate pain on the back of the hand, and there may be clinical deformity.

Clinical examination

The doctor will carefully ask the patient to bend and straighten the fingers to ensure they are aligned and do not twist on flexing. In addition to this the doctor will assess that the tendons both on the front and the back of the finger have not been injured during the accident.

Special features of this condition

The vast majority of metacarpal fractures can be treated non-operatively with early mobilisation. The little finger metacarpal is the most common, and this can accept a significant degree of angulation, without functional problems. However, the index and middle finger metacarpals can tolerate less angular deformity, and often require fixation. This photograph shows an index metacarpal fracture that is displaced, and is causing significant rotatory deformity. It will require fixation in an anatomical position with surgery.

Investigations

Plain x-rays are the mainstay of evaluating metacarpal fractures.

Non-operative treatment

The vast majority of metacarpal fractures occur in the little finger and require no operative treatment. Early mobilisation is the key to a successful outcome.

Operative treatment

This is usually reserved for severely angulated fractures, and also fractures involving multiple metacarpals. Fractures involved in the index and middle finger have an increased likelihood of requiring internal fixation due to the inability to tolerate angular deformity on this side of the hand. Operative treatment can include plates, screws and buried wires.

Post-operative rehabilitation

Early mobilisation of the hand aids healing and prevents tendons from sticking to the underlying bone.