Metacarpal fractures are a common hand injury and are usually the result of a traumatic mechanism of injury eg punching. That’s why you may hear them referred to as a “Boxer’s Fracture.”
This article will be based around the 2nd, 3rd, 4th and 5thmetacarpals and will largely exclude the thumb metacarpal (1st). The thumb metacarpal has some other important considerations and will be acknowledged independently.
What is a Metacarpal Fracture?
The metacarpals are the long bones that make up the hand. Your metacarpal bones can be injured/fractured at different areas: the base, shaft, neck or head. They occur mostly in men where the most common site of fracture is at the neck which is close to the knuckle. The 5th metacarpal (little finger) is the most commonly injured and is often a result of a punching injury – this is the classic punch gone wrong or ‘boxers fracture’.
The good news is the majority of metacarpal fractures are isolated, stable and are able to be managed conservatively. These fractures do well with conservative management and usually do not require surgery.
The metacarpal fracture pattern relates to the mechanism of injury and is similar to that of other long bones and may be oblique, spiral, transverse or comminuted. These patterns can result in angulation, rotation or shortening of the metacarpal which may cause an altered shape/appearance of the knuckle and there may appear to be some deformity present in the hand (usually a bump along the back of the hand). These are generally only a cosmetic issue and do not concern the function of the hand. They also tend to improve as the fracture heals.
Our expert Physiotherapists will examine the amount of rotational deformity when you make a fist to decide if a referral onto a specialist is warranted. Rotational deformities are more common in fingers 4 and 5 and can be less stable than if in fingers 1, 2 or 3
Treatment for a Metacarpal Fracture
The key to getting a good result after a metacarpal fracture (or any other fracture) and returning to full function is early management. Activate Physiotherapy offer same day appointments to attend their fracture clinic to ensure your metacarpal fracture is managed with the best management from the start.
Following your Xray our Physiotherapists will fit you into a custom hand based radial or ulna gutter splint. It is important that we set your hand position at the metacarpal-phalangeal joint between 70-90degrees. Most metacarpals will require immobilisation for between 3-5 weeks. It is important to note radiographic evidence of healing can take up to 5 months. Our approach is unique and our physiotherapists understand the importance of integrating your rehab during the healing process and will assist you with a rehabilitation program at the various stages of your healing journey. This reduces the complications that often occur from hand fractures.
How to Make a Fracture Clinic Appointment
No Xray? No problem!
We can arrange bulk-billed xrays to confirm diagnosis and monitor healing.
Need your cast removed?
We can help with that too! We are able to remove backslabs and full plaster or polyester casts