The metacarpal bones are the five long bones in the hand. Any of these bones can be broken or fractured but the 1st metacarpal under the base of the thumb is the most commonly injured. The fracture is usually caused by a direct impact which causes pain in the area. Treatment for these kinds of fractures usually involves immobilisation in a cast followed by strengthening exercises.
Symptoms of a fractured metacarpal
The metacarpals, particularly the base of the first metacarpal are usually fractured as a result of impact or sudden trauma such as punching something hard. Fractures can also occur as a result of a fall onto the hand where the thumb is extended out to the side.
Symptoms will include sudden pain usually from the impact. Trying to move the hand will be painful and swelling will usually develop along with bruising a bit later. In a severe fracture known as a displaced fracture, the hand will appear deformed.
Types of metacarpal fracture
Fracture of the base of the first metacarpal can occur from punching a hard object such as a wall or someone's head or from a fall onto a sticking out a thumb. There are two forms of metacarpal fracture which may occur. A transverse fracture near the base of the thumb results in the thumb being positioned across the palm of the hand. Treatment for this type of fracture should be a reduction or re-positioned of the bone back where its normal position is followed by 4 to 6 weeks in a plaster cast.
A Bennett's fracture dislocation of the joint between the metacarpal and the carpal bones of the wrist is a specific and more serious injury requiring surgical treatment from a specialist wrist and hand surgeon.
Fractures of any of the other four metacarpals can also occur from a punch. The 4th and 5th metacarpals are most commonly injured and this is known as a boxer's fracture. Treatment usually requires casting or splinting for 2 to 3 weeks before rehabilitation exercises can begin.
Treatment of metacarpal fractures
Most metacarpal fractures which are straightforward without other complications are treated with immobilization in a plaster cast or splint for a period of 2-6 weeks depending on the type of fracture. More complex fractures or those with a displacement of the bones may require surgery.
Rehabilitation of metacarpal fractures involves regaining the strength of the intrinsic muscles of the hand. Items such as hand putty and therapy balls can be great for doing this.