Understanding Metacarpal fractures: Causes, Symptoms, Prevention, and Effective Treatments
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on August 3, 2024
Metacarpal fractures are common injuries involving the long bones of the hand, typically caused by direct trauma or excessive force. They present significant challenges in clinical management due to their impact on hand function and patient quality of life. Timely and accurate diagnosis, followed by appropriate treatment, is crucial to ensure optimal recovery and prevent long-term complications.
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What is a metacarpal fracture?
A metacarpal fracture refers to a break in one of the five metacarpal bones, which extend from the wrist to the base of the fingers. These fractures vary widely in type and severity, influencing treatment strategies and outcomes.
Detailed explanation of metacarpal bone anatomy
Each metacarpal bone consists of a shaft and two ends: the base towards the wrist and the head towards the fingers. They articulate with the wrist bones proximally and the finger bones distally, forming crucial joints for hand movement and dexterity.
Description of the hand's structure and function
The hand is a complex structure comprising bones, joints, ligaments, tendons, and muscles, enabling precise movements and grip strength essential for daily activities.
Types of metacarpal fractures
Transverse fractures: Occur horizontally across the bone shaft.
Spiral fractures: Twist around the bone due to rotational forces.
Oblique fractures: Angled across the bone shaft.
Comminuted fractures: Shattered into multiple fragments.
Specific focus on boxer's fracture (5th metacarpal fracture): Commonly seen in individuals who strike objects with a closed fist, leading to a fracture of the 5th metacarpal neck.
Causes and risk factors of metacarpal fracture
Common causes: Metacarpal fractures often result from direct impacts such as punching a hard surface, falls on outstretched hands, and crushing injuries. Sports activities like boxing, martial arts, basketball, volleyball, and accidents during cycling and skiing also contribute significantly.
Occupational hazards: Workers in construction and manufacturing sectors are at increased risk due to occupational hazards, including repetitive stress injuries.
Risk factors: Factors such as age-related changes in bone density, previous hand injuries, and medical conditions affecting bone strength predispose individuals to metacarpal fractures.
Signs and symptoms of metacarpal fracture
Pain and discomfort: Metacarpal fractures typically manifest with localized pain, varying in intensity depending on the severity of the fracture.
Swelling and bruising: Edema and bruising patterns around the injured area are common, indicating soft tissue damage and bleeding.
Deformity and functionality: Visual inspection may reveal deformities like angulation or shortening of the affected finger, accompanied by impaired hand function such as difficulty gripping objects or reduced range of motion.
Potential complications: Complications include malunion (improper healing), leading to stiffness, reduced mobility, and chronic pain if not managed promptly and effectively.
Diagnosis of metacarpal fractures
Physical examination: Initial assessment involves visual inspection for swelling and deformity, palpation to localize tenderness, and range of motion tests to evaluate hand function.
Imaging techniques: X-rays are standard for diagnosing metacarpal fractures, providing crucial information about fracture alignment and displacement. CT scans and MRI may be necessary for complex cases to assess intra-articular involvement and soft tissue damage.
Differential diagnosis: Distinguishing metacarpal fractures from other hand injuries such as sprains, strains, tendon injuries, and different types of hand fractures is essential for accurate treatment planning.
Treatment options for metacarpal fracture
Non-surgical treatments
Immobilization techniques: For non-displaced or minimally displaced metacarpal fractures, immobilization is crucial for promoting healing and preventing further injury. This is typically achieved through:
Splinting: A removable device that supports and protects the injured hand while allowing for some movement to prevent stiffness.
Casting: Involves encasing the hand and wrist in a rigid cast to immobilize the fracture completely. This method is often used for more complex or unstable fractures.
Duration of immobilization: The duration of immobilization varies based on the severity and location of the fracture, typically ranging from three to six weeks. Regular monitoring with X-rays helps determine when immobilization can be safely discontinued.
Pain management: Managing pain is an essential aspect of treatment. Options include:
Over-the-counter medications: Such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or acetaminophen to alleviate pain and reduce inflammation.
Prescription pain relievers: Stronger medications may be prescribed for more severe pain or when over-the-counter options are insufficient.
Ice therapy: Applying ice packs to the injured hand helps reduce swelling and relieve pain, especially in the initial stages following injury.
Surgical interventions
Indications for surgery: Surgical intervention for metacarpal fractures is typically considered in the following cases:
Displaced fractures: When the bone fragments are significantly out of alignment and unlikely to heal properly without surgical realignment.
Rotational deformities: Fractures that result in rotational misalignment, affecting hand function and alignment.
Multiple fractures: Cases involving multiple fractures in one or more metacarpal bones that require stabilization to promote proper healing.
Common surgical oprocedures:
Closed reduction and percutaneous pinning: This procedure involves manually realigning the fractured bone fragments under fluoroscopy or X-ray guidance. Once aligned, the fragments are held in place with pins or wires that are placed through the skin and into the bone to maintain alignment during healing.
Open reduction and internal fixation (ORIF): In more complex fractures or those where closed reduction is not feasible, ORIF may be performed. This involves surgically exposing the fracture site, realigning the bone fragments, and securing them with screws, plates, or other fixation devices to stabilize the fracture and promote proper healing.
Post-surgical care and recovery:
Following surgical intervention for metacarpal fractures, post-operative care is crucial to ensure optimal healing and recovery:
Immobilization: The hand may be immobilized with a splint or cast to protect the surgical repair and allow initial healing.
Physical therapy: Rehabilitation exercises are initiated to improve range of motion, strength, and function of the hand. These exercises are gradually intensified under the guidance of a physical therapist to promote recovery.
Follow-up: Regular follow-up visits and X-rays are scheduled to monitor healing progress and ensure that the fracture is healing correctly without complications.
Physiotherapy for metacarpal fractures
Role of physiotherapy in recovery
Physiotherapy plays a crucial role in the rehabilitation of metacarpal fractures, focusing on restoring hand function, improving range of motion, and promoting strength and coordination.
Improving range of motion:
Physiotherapists utilize techniques to restore the full range of motion in the injured hand through targeted exercises and stretching routines.
Strengthening exercises:
Specific exercises are prescribed to strengthen the muscles of the hand and forearm, essential for regaining grip strength and overall hand function.
Pain management techniques:
Physiotherapists employ various methods to manage pain, including manual therapy techniques, modalities such as ultrasound or electrical stimulation, and advising on appropriate pain-relief strategies.
Specific techniques and exercises:
Manual therapy: Hands-on techniques performed by the physiotherapist to mobilize stiff joints, release tight muscles, and improve tissue flexibility.
Passive and active range of motion exercises: Passive exercises involve the therapist assisting the patient in moving their hand, while active exercises require the patient to perform movements independently to regain flexibility and function.
Grip and pinch strength exercises: Targeted exercises to enhance grip strength and precision, crucial for activities of daily living and occupational tasks.
Proprioception and coordination activities: Exercises to improve proprioception (awareness of limb position) and coordination, helping the patient regain control and precision in hand movements.
Stages of rehabilitation:
Early phase (Protection and pain control): Focuses on protecting the healing fracture, controlling pain, and preventing stiffness through gentle range of motion exercises.
Intermediate phase (Mobility and strength): Intensifies exercises to improve mobility, strength, and endurance of the hand and forearm muscles.
Late phase (Return to activities): Gradual return to functional activities and tasks, aiming for full restoration of hand function and strength.
Expected outcomes:
Timelines for recovery: Recovery timelines vary based on the severity of the fracture and adherence to rehabilitation protocols, typically ranging from several weeks to a few months.
Factors affecting rehabilitation success: Success in rehabilitation depends on factors such as patient compliance with exercises, severity of the initial injury, age, overall health, and any complications during healing.
Prevention strategies for metacarpal fracture
Protective Equipment in Sports: Properly fitting hand wraps and gloves are essential in sports like boxing to cushion impacts and reduce the risk of metacarpal fractures. Wrist guards should be worn in activities such as skateboarding and snowboarding to protect against falls and direct trauma to the hand.
Workplace Safety Measures: In occupational settings, wearing protective gloves can mitigate the risk of hand injuries. Employers should also provide ergonomic tools and equipment designed to reduce strain and minimize the likelihood of accidents.
General Hand Safety Tips: Learning proper techniques for falling, such as rolling rather than using hands to break a fall, can prevent fractures. Avoiding direct impacts to the hand during activities and using caution in hazardous environments further reduces the risk.
Recovery and long-term outlook
Typical Recovery Timeline: The healing process of metacarpal fractures follows phases of bone healing, including inflammation, soft callus formation, hard callus formation, and remodeling. This generally spans several weeks to months, depending on the severity of the fracture and individual healing factors.
Milestones in the Recovery Process: Milestones include gradual improvement in pain levels, increasing range of motion, and the ability to perform daily activities without discomfort. Physical therapy plays a crucial role in achieving these milestones.
Potential Long-term Effects: Some individuals may experience residual stiffness or weakness in the hand following a metacarpal fracture. There's also a potential risk of developing arthritis in the affected joint over time.
Return to Activities and Work: Reintroducing daily activities and work tasks should be gradual, starting with lighter tasks and progressing as strength and flexibility improve. Specific guidelines for returning to sports or physical jobs should be followed to minimize the risk of re-injury.
When to seek professional help
Red Flags and Warning Signs: Seek immediate medical attention if you experience severe pain, swelling, obvious deformity, or numbness or tingling in the fingers. These symptoms may indicate a more severe fracture or complications that require prompt evaluation and treatment.
Choosing Between Emergency Care and Scheduled Appointments: If symptoms are severe or if there is uncertainty about the severity of the injury, go to the emergency room for immediate evaluation. Otherwise, schedule an appointment with a healthcare provider for comprehensive assessment and treatment planning.
Importance of Follow-up Care: Regular follow-up appointments are essential to monitor healing progress, adjust treatment plans as needed, and ensure optimal recovery outcomes. Adhering to rehabilitation guidelines provided by healthcare professionals supports long-term hand health.
Conclusion
In conclusion, metacarpal fractures are common injuries that can significantly impact hand function and quality of life. Prompt and accurate diagnosis, followed by appropriate treatment and rehabilitation, are crucial for optimal recovery. By implementing preventive measures, seeking timely medical attention, and adhering to rehabilitation protocols, individuals can effectively manage metacarpal fractures and reduce the risk of long-term complications.
References:
Kollitz, K. M., Hammert, W. C., Vedder, N. B., & Huang, J. I. (2013). Metacarpal Fractures: Treatment and Complications. HAND, 9(1), 16–23. https://doi.org/10.1007/s11552-013-9562-1
Carreño, A., Ansari, M. T., & Malhotra, R. (2020). Management of metacarpal fractures. Journal of Clinical Orthopaedics & Trauma, 11(4), 554–561. https://doi.org/10.1016/j.jcot.2020.05.043
Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.