Metacarpal fractures: the swollen hand!

If you have a broken hand, you likely have sustained a metacarpal fracture—an injury to the bone at the level of the palm of your hand.1 You have five metacarpal bones, one for each of your fingers. The metacarpal bones support the hand, and the end of the metacarpal bone forms the knuckle on the back of your hand.

Typical symptoms of a metacarpal fracture include pain and swelling of the hand. While bruising may not be seen immediately, there is usually bruising that develops within a few days of the injury.

Patients typically notice stiffness of the fingers and pain when trying to form a fist. Symptoms will gradually improve as healing takes place. Most metacarpal fractures fully heal in about 10 weeks, therefore it's normal to have some stiffness and swelling for that length of time.

Causes

Metacarpal fractures can occur with a variety of injuries, including:2

• Falls

• Sports injuries

• Fistfights or punches

• Car accidents

Diagnosis

Metacarpal fractures are generally described by the location of the fracture. Fractures in the center of the bone are called metacarpal shaft fractures. Fractures by the base of the finger at the knuckle are called metacarpal head fractures.

Lastly, fractures at the wrist-end of the bone are called fractures of the base of the metacarpal. The location of the actual fracture is also important in determining the best treatment for the injury.

Treatment

Treatment of a metacarpal fracture can usually be accomplished with the use of a cast. A cast is usually worn for three to six weeks, followed by gentle motion exercises.2 Occasionally, if stiffness becomes a problem after cast treatment, a hand therapist will be recommended to work with you.

There are a few situations where surgery may be recommended. If there are multiple fractures or open fractures of the hand, surgery may be recommended. In the setting of an isolated metacarpal fracture, your healthcare provider will assess two factors to determine if surgery is necessary:3

• Length: Your healthcare provider will determine if the finger is shortened because of the fracture. If it is, your practitioner may recommend surgery to restore the normal length of the finger.

• Rotation: If the finger is rotated, your healthcare provider may recommend that this deformity gets corrected. Rotation can be assessed by making a fist. If the fingers cross over each other, there is likely a rotational deformity.

If surgery is needed, your healthcare provider may fix the broken bone with pins, plates, or screws. The type of fixation depends on the specific type of fracture.

Fractures located at the head or the base of the metacarpal may also require surgical treatment if the joint surface of the bone is involved in the fracture. In these situations, the movement that occurs at the joint can be altered, and this may lead to the need for surgical treatment.