Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609
What is a metacarpal fracture?
Metacarpal fractures are common hand injuries in people. They can occur from a variety of injuries such as a fall, a motor vehicle collision, or striking the fist against a hard surface. There are five metacarpals -- one for each finger and the thumb. The metacarpals contribute to the bony architecture of the hand. Satisfactory healing of this fracture is important to restoring overall hand function. A fracture of the metacarpal neck of the small finger is sometimes called a “boxer’s fracture” as they can be seen in punching injuries.
The image to the right shows an angulated fracture of the 5th metacarpal shaft. "Fracture" is simply the medical term for "broken bone."
What are the treatment options?
Our treatment plan will depend on the severity of the fracture as noted on the x-rays and the patient’s medical condition, activity level, and desires. Most people have fractures which are well-aligned, and, therefore, do not require surgery. Treatment in these cases is typically rest and protection in a cast or brace for 4-6 weeks. Follow-up x-rays are obtained in clinic to evaluate how the fracture is healing. Some fractures can be re-aligned with manipulation (without surgery) called "closed reduction", and those patients can also be treated non-operatively.
Hand therapy can be helpful in improving finger range of motion and strength after the fracture heals, but it is not always required. A firm “bump" is often noticed at the fracture site during healing. This is composed of new bone formation, the body's normal response to heal the fractured bone. This can be seen on x-ray and is called the "fracture callus."
Some patients have fractures which are more severe and the alignment of the fracture may not satisfactory. Fractures which involve the joint surface are often more severe. Depending on the patient’s health and activity level, surgery may be advised to improve and maintain the alignment of the bones.
What is involved with surgery?
The surgery is usually performed on an outpatient basis using either regional anesthesia or general anesthesia. During the surgery I improve the alignment of the fracture and use an implant to stabilize the pieces. In some cases, I use a low-profile plate and/or screws to fix the bones internally. The orthopedic hardware is covered by the skin and soft tissues of the hand and rests against the surface of the bone. This is called “open reduction and internal fixation” and requires an incision on the back of the hand. In other cases, I use temporary pins to hold the fragments aligned while they heal. This is called “closed reduction and percutaneous pinning.” The pins can be removed in clinic after a few weeks. Which technique is used depends on the patient and fracture pattern and is often determined in the operating room.
Surgery does not actually "heal" the fracture; it simply allows the bones to be held in good alignment while the body bridges the fracture site with new bone. This healing process takes a few weeks.
What can I expect after surgery?
Rest and elevation of the hand to the level of the heart is very import for the first few days after surgery to reduce swelling. Shoulder and elbow range of motion exercises are important to help prevent stiffness in these joints. The first few days after surgery can be quite painful, and medications will be prescribed to help. These medications should be weaned as the pain subsides.
Your wrist and fingers will be protected in a plaster splint after the surgery. The splint will be removed in clinic after a few days and a removable splint will be provided. At this point, most patients can begin gentle wrist and finger range of motion with the oversight of a therapist. However, some patients need an additional few weeks of casting to protect the repair, depending on the severity of the fracture. I recommend avoiding heavy lifting, pulling, pushing or gripping until the fracture heals, approximately 6 weeks after surgery.
Pain, swelling, and stiffness gradually improve over time. Most patients can return to more normal function at about 2 months post-operatively, but maximum improvement can take 6 months or more. Recovery time varies among patients, depending on the severity of the injury, possible complications, and pain tolerance of the patient. Occasionally, patients have stiffness and “ache” in the hand and fingers after treatment. Fractures which injure the joint surface are more prone to complications such as stiffness and arthritis. My goal is to help each patient obtain the most function possible after the injury.
What are the complications from surgery?
No surgery is risk-free. However, the risk of major complications from metacarpal fixation is low. Possible complications include pain, bleeding, infection, swelling, stiffness, nonunion, malunion, hardware failure, and damage to the surrounding nerves and blood vessels. A fracture which fails to unite is known as a nonunion. A fracture which heals with deformity is known as a malunion. Other complications are also possible but are uncommon.
What can I do to improve my results?
Adequate nutrition is important during the healing and recovery process. I recommend a diet rich in protein and calcium and an adequate intake of calories per day while your body is healing. If you smoke, reducing or eliminating tobacco use will decrease your risk of nonunion, delayed healing, and infection. Complying with the therapist’s recommendations is very important to maximize your result. The natural tendency of the hand after trauma is to become "stiff." Dedication to a home exercise program or hand therapist can be valuable in reducing the chance of hand/finger stiffness and grip weakness.
How can I prevent this from happening again?
Some metacarpal fractures are related to reduced bone density or osteoporosis. Most people with osteoporosis can decrease their fracture risk with lifestyle changes and medication, and I will discuss this with you during your care.
See below for examples of post-operative x-rays:
This material is intended for general reference only and does not replace an evaluation by a physician.
If you have a possible broken finger or hand injury, please call 919-872-3171 or visit www.raleighhand.com to be evaluated promptly at the Raleigh Hand Center.
Copyright 2013 Erickson Hand Surgery
Raleigh Hand Center
3701 Wake Forest Rd
Raleigh, NC 27609