A metacarpal fracture is a fracture of one of the bones in the hand. The metacarpal bones are the long bones found in the hand and thumb. This injury may be sustained through various different mechanisms causing blunt force trauma to the hand, but most commonly caused by a clench fist strike with injury to the small finger or 5th metacarpal commonly known as a “boxer’s fracture.” Sometimes multiple metacarpals are fractured.
Metacarpal fractures are most commonly diagnosed with x-rays. Some fractures are evident from the deformity that is visualized just by looking at the injured hand.
Some metacarpal fractures can be treated with buddy taping the injured finger to an adjacent uninjured finger. Usually buddy taping is required for 6 weeks. In some instances surgery is required to stabilize the fracture. Many different techniques are used to fixate metacarpal fractures. Some fractures can be treated with wires inserted percutaneously, while others require open reduction and internal screw fixation.
There are many different techniques available to treat metacarpal fractures. Mainly because there are many different fracture patterns and degrees of injury. Three of the most common techniques are percutaneous pin fixation, open treatment with intramedullary headless compression screws, and plate and screw fixation. Some fractures are best treated with manual reduction and pins inserted through the skin. Depending on the specific characteristics of a fracture, the best suited technique is used to provide the best outcome. Sometimes a variety of internal screws and external pins are used in combination.
If percutaneous pins have been placed, you can expect for them to be left in place for 4-6 weeks on average. These pins exit the skin and are covered with protective caps. While the pins are in place they are to be protected from being bumped and must be kept clean and dry. This means showering becomes difficult, but this can be managed with the use of a plastic bag. There are many plastic bag options on amazon.com, but umbrella covers work well also. Patients can expect to see an occupational therapist for both treatment as well as splint fabrication. Typically a patient is kept to light duty only for 6-8 weeks while the fracture heals. Full activity can be expected around 8 weeks.
If internal hardware is used, it is designed to stay in forever. This typically allows for earlier mobilization, however does require an incision to be made. If a plate and screws are used, patients can expect to start a more aggressive mobilization protocol with therapy at an earlier phase in healing. Depending on healing characteristics weight bearing is held until week 4-6. Full activity is typically achieved around 6-8 weeks.
If headless compression screws are used immediate mobilization in buddy tape is safe. Typically weight bearing is started around weeks 3-4 and full activity week 6. Typically no therapy is needed for these patients.