The metacarpal bones lie between the carpal bones and the three finger bones (or two finger bones of the thumb). These can break as a result of trauma, for example a punch or a fall on the hand. This means that the bone has a break in continuity. The bone fragments can also be displaced (displaced). If the bone fracture is visible in the wound, it is called an open fracture, otherwise it is a closed fracture. The fractures of the 1st metacarpal bone, which is part of the thumb, are named again (Winterstein, Bennet and Rolando fractures). If the fracture is not dislocated, immobilization in the cast is often sufficient, otherwise it must be straightened and splinted in an operation.
Causes of a metacarpal fracture
A fracture in a person without previous illnesses occurs through the action of force, such as catching a fall with the now broken hand or through a blow. The fracture of the 5th metacarpal bone (close to the body of the little finger) is also known as a "boxer's fracture". If the bone is already damaged on its own, for example by osteoporosis (with reduced bone density), by a bone cyst, a tumor or a bone metastasis from another tumor, the metastatic bone can break even with a slight impact, for example when bumping into a Furniture edge.
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If a metacarpal bone breaks, pain, especially tenderness and pain when moving, may occur. The hand can also swell. Sometimes the interruption or protrusion of the bone can already be seen or felt from the outside. The affected area may be abnormally mobile. In addition, when moving the broken bone, you can hear the two bone ends rubbing against each other, so-called crepitations. Depending on the type of break, there may also be an open wound.
More information can be found here: Bone chippingAppointment with a hand specialist?
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A metacarpal fracture is often accompanied by swelling, as blood vessels are injured in addition to the bone. Blood can leak out at these points and lead to swelling, as well as turning blue ("blue spot"). The lymphatic system can also be impaired and with it the removal of tissue fluid back to more central areas of the body and blood vessels.
Most fractures are very painful immediately after the fracture. Sometimes the pain can be burning too. The hand hurts particularly when the affected hand is moved - so the body warns against continuing to use the broken hand. Touching is also perceived as very uncomfortable.
More information and causes of Wrist pain you'll find here.
Diagnosis of a metacarpal fracture
The attending physician (for example the family doctor first, or an orthopedic surgeon / trauma surgeon as a specialist) asks what has happened and what symptoms have been noticed. He or she will examine the affected hand, paying particular attention to a wound with visible bone, bone rubbing, step formation in the appropriate area, and abnormal mobility. The blood flow, movement and strength as well as the feeling of the fingers should always be checked so as not to overlook any damage.
To confirm the suspicion of a break and to know more precisely where the break is, an X-ray of the hand is taken in two planes. The interpretation of the X-ray images allows the diagnosis of a metacarpal fracture and how the broken ends of the bones relate to each other. If the findings are still unclear, computed tomographic imaging (CT) may be necessary. If there is suspicion that soft tissues such as muscles are severely injured or that a nerve or vessel is also affected, magnetic resonance imaging (MRI) can help.
For more information on diagnostics, read too: MRI of the hand
Therapy of a metacarpal fracture
The most suitable therapy is selected based on the findings. This also depends on the age and other condition of the patient: If there are other serious injuries, these may need to be treated first. There are patients who should not have an operation because other diseases bring too great a risk when performing anesthesia. Children tend not to operate - since the child's skeleton is not yet mature, it can “repair itself” better.
Otherwise, fractures that lie outside a joint and are located near the end of a bone are treated with a forearm thumb splint. If the long middle part (the shaft) of the bone is broken but not slipped, the break can be treated with a forearm plaster splint that is placed on the inside of the arm. The cast has to be worn for several weeks and checked regularly. The affected hand or arm should also be spared during the treatment and all strains and other dangers should be avoided. All other fractions, e.g. affect a joint or are severely displaced (dislocated) are operated on. Special fracture shapes are always treated surgically.
You may also be interested in this topic: Broken wrist and Broken finger
When do you need an operation?
If the ends of the bones are not straight on top of each other or the adjacent joint is affected, surgical straightening and fixation is necessary. There are also types of fracture - the Bennett or Rolando fracture of the first metacarpal bone - which are always treated in one operation. It is only through the surgical procedure that it is ensured that the fracture is just growing back together and that the mobility of the adjacent joints is not restricted later.
How is a metacarpal fracture operated?
A metacarpal fracture can generally be operated on under general anesthesia - but mostly only local anesthesia (regional anesthesia) or anesthesia of the affected arm (plexus anesthesia) is performed. This is discussed in detail with the patient and the advantages and disadvantages are weighed up. Often this fracture is also treated in an outpatient operation, since it is not an overly difficult or long procedure. This means that after a few hours of monitoring, you can go home the same day. You only have to come back to the clinic or practice for controls.
An incision is made to gain access to the affected bone and bring it back into the correct position. Then this corrected position has to be fixed with the help of osteosynthesis material such as wires or plates.
If the bone parts are displaced or there is a so-called Winterstein fracture, in which the part of the first metacarpal bone close to the body is obliquely broken outside the joint, a Kirschner wire osteosynthesis or a mini-plate osteosynthesis is carried out.
If an adjacent joint is involved, a mini-T-plate is inserted.
The so-called Bennett (fracture with dislocation of the thumb saddle joint) and the Rolando (also involvement of the thumb saddle joint) fractures are always treated surgically and are given an osteosynthesis variant either with Kirschner wires, a lag screw or a mini-plate.
Duration of healing of a metacarpal fracture
The duration of a plaster treatment without surgery is approximately 3 to 6 weeks. The success of the treatment should be checked with an X-ray. Then you should slowly increase the load and work consistently on the mobility of the hand.
Even with a surgical procedure, the healing time is about 6 to 8 weeks. Since the fracture has been mechanically stabilized here, it can be done earlier, often after a few days, with careful movement and exercise of the hand, e.g. through physiotherapy.
Unfortunately, however, it can also happen that the two ends of the fracture do not grow back together and thus form a “false joint” (pseudarthrosis). One speaks of this if healing has not occurred after 6 months.
Read more on the subject Plaster casts.
How long will you be on sick leave?
The length of the sick leave depends largely on how much the hand is used in everyday work. For example, if someone works as a construction worker, the fracture must have healed stably before it can be used again.
This can then e.g. be the case after 6 weeks. To make it easier to get started, a stress test can also be carried out: you first work a defined shorter number of hours per day and are still on sick leave. Then you can slowly increase.
However, it may also be possible to continue working with the other hand so that work can be started again soon after an operation or conservative treatment, for example a week later.