Metacarpal fracture

A fracture is the same as a broken bone. The metacarpals are the bones that form the palmar section of the hand. A fracture to a metacarpal can occur at any part of the bone, but is most common at the ‘neck’, up near the knuckle. The most commonly fractured metacarpal is the fifth one, joining up to your little finger. This is called a ‘boxer’s fracture’ as it is commonly caused when punching an object.

What causes a metacarpal fracture?

As with any fracture, the severity will depend on the direction, location and amount of force that caused the bone to break. In some cases, the fracture will need to be ‘put back in place’ under anaesthetic to make sure the bone heals in the right position. Fractures that involve the joint, are in more than two pieces or are displaced (not sitting in the correct position) are more likely to need surgery.

Metacarpal fractures are mostly caused by hitting something hard with your hand while your fist is clenched.

The metacarpal is narrow at the neck, which is the most common place for it to break; however, it can occur anywhere along the bone depending on the direction and force of impact to the bone.

How do I know if I have a metacarpal fracture?

In most cases, you will have pain and swelling straight away at the fracture site.

You may still be able to move your fingers, although it will be sore to move and touch the area.

The finger may look different—the knuckle may ‘disappear’, the finger may point in a slightly different direction or look a little bit shorter—and there may be a lump in the palm of the hand or on the back of the hand. You can check the finger alignment by making a loose fist to make sure the fingers are not ‘scissoring’ or crossing over each other.

Some people experience very little pain. This is because the metacarpals have lots of supporting structures around them, like ligaments and muscles.

Diagnosis will be confirmed on X-ray by a GP or physiotherapist. Depending on how bad the fracture is, treatment may either involve a splint to hold the fracture in place or surgery to make sure your fracture heals in a good position.

How can physiotherapy help with metacarpal fractures?

The first thing that’s needed is an X-ray to work out which bone is broken and to what extent. This will guide what treatment is necessary. Your GP or physiotherapist will also look at your hand and do some gentle tests to work out if surgery is needed. If surgery is not needed, then your physiotherapist will make a custom splint, which will support the healing fracture.

Physiotherapy is extremely important following a metacarpal fracture. Under your physiotherapist’s instructions, you will start moving as soon as it is safe to ensure that you don’t get too stiff. Physiotherapists use a number of techniques to regain movement in your hand, wrist and fingers, including:

swelling management with massage and compression garments
soft tissue massage to help with muscle tension and pain
providing you with a home exercises program of specific movements and strengthening exercises.

It’s important to note that not all physiotherapists are specialised in the area of hand therapy. For the best treatment outcome, find a physio who specialises in this area.

How effective is physiotherapy for a metacarpal fracture?

Metacarpal fractures are a very common hand injury. The chances of you having a speedy recovery with a good outcome are maximised by following your physiotherapist’s advice. You must have the hand resting in the right position for healing, for the right amount of time, regardless of whether you have had an operation or not.

It is important to commence moving as soon as it is safe to prevent stiffness in your hand. Your physiotherapist will guide you about when to start some gentle exercises, as well as when it is safe to remove your splint for certain exercises.

After surgery, to fix a metacarpal fracture, it’s important to get moving early, but safely, to ensure the tendons in your hand don’t get stuck in the healing scar tissue. Your physiotherapist will provide you with exercises to do depending on how the fracture has been fixed.

Later on, when the bone is strong enough, your physiotherapist can help with regaining the strength you require for all your normal daily activities.

What can I do at home?

In the early phases, ice and compression can be helpful in reducing swelling. It is also important to rest and elevate your hand as much as you can. Also, you need to make sure your shoulder, elbow and unaffected fingers don’t get too stiff, so move them gently and carefully a few times a day.

It is important to follow the advice given to you by your physiotherapist. During the time you are in a splint, you should minimise the use of your injured hand and wear the splint as instructed. It is also important to complete the exercises your physiotherapist gives you or you may end up with a very stiff hand.

How long until I feel better?

It may take several weeks for the healing fracture to become strong, but you may be able to do many day-to-day tasks prior to this. You may not be able to drive for the first few weeks, and some activities will be restricted. From about six weeks you will be able to gradually return to your activities, guided by your physiotherapist.

METACARPAL FRACTURE

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