Metacarpal and Phalanx (Hand & Finger) Fracture

The bones in the hand include the metacarpals, which are the long bones within the palm, and the phalanges, which are the small bones within the thumb and fingers. A fracture or break of these bones may occur due to a variety of traumatic mechanisms. One of the most common fractures of the hand and fingers is a “boxer’s fracture”, which is a fracture of the neck of the fifth metacarpal.

Initial evaluation includes x-rays. Sometimes, a CT scan is necessary. Fractures may be “non-displaced”, meaning the bone fragments have not shifted, or “displaced”, meaning the bone fragments have shifted. It may then be “comminuted” if it is broken into multiple pieces. “Open fractures” are when pieces of the bone break through the skin, which can increase the risk of infection. The other important component of the evaluation is the clinical exam. These fractures may cause deformities of the fingers known as “scissoring” or “malrotation”, which affects the position of the fingers. If this is the case, surgery often is necessary.

Depending on the pattern of the fracture, or the degree of displacement and comminution, and whether this pattern is stable or unstable, and depending on the presence of clinical deformity in the fingers, these fractures may be treated non-operatively or operatively. Non-operative treatment often involves placement of a cast, splint, or buddy tape, for up to 6 weeks while the fracture heals. Operative treatment involves a surgery in which the bones are re-aligned and held in position using metal plates, screws, or pins. In some situations, this may be done “closed” in which no incisions are made and only metal pins are inserted through the skin and into the bone. In other situations, this may be done “open”, in which incisions are made to expose the fracture and permit re-alignment of the bony fragments.

The broken bones must be immobilized long enough to permit healing of the fracture. Depending on whether or not surgery is performed, motion may begin anywhere from immediately after treatment to 6 weeks later. Beginning motion is important to prevent stiffness from developing in the hand and fingers. Often, it is necessary to work with a hand therapist to reduce stiffness and improve motion. Typically, patients regain excellent hand function, but sometimes stiffness is limiting enough to warrant surgery for surgical removal of implanted hardware, tenolysis, and contracture release.

Be sure to see an experienced surgeon to treat this condition. Our fellowship-trained specialists at The Buncke Clinic in San Francisco treat patients with metacarpal and phalanx (hand and finger) fractures from across the Bay Area and Northern California. Contact us to schedule a consultation.

Below are links for third party resources

American Society for Surgery of the Hand

American Academy of Orthopaedic Surgeons