In a metacarpal fracture, one or more of the five metacarpal bones are broken. The cause is usually an impact trauma or a punch. A metacarpal fracture can be treated either conservatively or surgically. Here you will find further information and selected specialists for the treatment of a metacarpal fracture.
Doctors define a metacarpal fracture as a fracture of one or more metacarpal bones.
The five metacarpal bones (metacarpalia in Latin) form the connection between the carpal bone and the finger bones.
Depending on the position of the fracture line on the bone, the following fractures can be distinguished:
A distinction is also made between fractures of the first metacarpal bone (thumb) and the other metacarpal bones.
Common causes of a metacarpal fracture include impact trauma and a blow from a fist. Men are usually affected at a younger age.
Experts often refer to metacarpal fractures as boxer's fractures because they are often caused by a blow to a hard object @ bilderzwerg /AdobeStock
A metacarpal fracture is characterized by severe pain. In addition to swelling of the hand, a hematoma (bruise) can often be observed.
The mobility of the hand is severely restricted. In the case of an open metacarpal fracture, fragments of the affected bone(s) protrude through the skin.
A fracture of the thumb wrist is characterized by pain when moving the forearm. An obvious misalignment can also be symptomatic.
A fracture of one or more metacarpal bones is usually caused by trauma resulting from direct force. These can be caused by an impact, for example in an accident.
A metacarpal fracture often occurs as a result of a punch. Metacarpal fractures often occur in young men. Craftsmen are also particularly at risk. The risk of a metacarpal fracture is particularly high where violence can affect the hand.
The first metacarpal, which leads to the thumb, has a special position in the metacarpal bones. It is more frequently affected by a fracture than the other bones of the metacarpal.
Doctors distinguish between three types of fracture:
In a Bennett fracture, the fracture line runs from the base of the bone to the saddle joint.
A fracture gap in the shape of a Y or T is typical of a Rolando fracture.
A Winterstein fracture is a transverse fracture. It occurs at the base of the bone and does not extend into the joint space.
The examination to determine whether a metacarpal fracture is present is carried out by an orthopaedic specialist. During the examination, the doctor will take a medical history, in particular the cause of the accident, the pain and the mobility of the hand.
The doctor examines the hand for the presence of symptoms. X-rays are required to confirm the diagnosis. If the joint is injured, a CT or MRI scan may be helpful.
When treating a metacarpal fracture, doctors distinguish between two basic methods:
The following applies as an immediate measure:
Ice cubes and cool packs wrapped in a cloth are used to cool the joint.
You should elevate your arm to prevent increased blood flow to the finger and swelling of the hand.
Rings, bracelets and other jewelry on the hand should be removed. The swelling of the fingers and hand could disrupt blood circulation.
Conservative treatment is the more moderate of the two alternatives. Doctors use it if the fracture is stable and the bone fragments are not displaced.
In conservative treatment, the doctor applies a plastic splint or plaster cast for four to six weeks. The fracture is set under local anesthesia.
If the 2nd to 5th metacarpal finger is broken, the thumb can remain unsplinted. Once the splint has been removed, it is usual to wear a compression glove. Physiotherapy can begin at the same time.
In the case of non-displaced fractures, it is sufficient to immobilize the hand with a splint @ Katja /AdobeStock
Surgical treatment is always considered if the bone fragments have displaced. Even if a step has formed as a result of the fracture.
Surgery ensures that the joint surfaces are correctly aligned. If such a metacarpal fracture is not operated on, there is a risk of malalignment. This in turn can lead to individual or multiple movements of the hand no longer being possible.
The following metacarpal fractures usually require surgery:
In general, surgically treated metacarpal fractures heal well. In individual cases, deformities or restrictions in movement may remain.
The operation is usually performed under general anesthesia or anesthesia of the arm. The surgeon first sets the bone fragments in the correct position. Stabilization is achieved using screws, plates or wires.
The course and prognosis for metacarpal fractures are usually good. After about three weeks, a so-called callus, a new bone tissue, forms. In most cases , patients can begin weight-bearing movement after around five weeks.
The surgical treatment method can involve general surgical risks. In addition, infections can occur , for example when the wire is inserted.
If plates are used, in rare cases these can lead to the flexor and extensor tendon sticking together.
Complications can occur if a metacarpal fracture is accompanied by injury to the neighboring tendons, nerves and vessels.
Only in rare cases does a metacarpal fracture not heal. This means that the fracture ends of the bones do not grow together. A so-called false joint is formed. In this case, (further) surgery may be necessary.
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