The hand consists of five bones called metacarpal bones for all the five fingers.1 The knuckles at the back of the hand are formed by the end of the metacarpal bones, which also assist or support the hand. Metacarpal fracture occurs when one of the long bones get injured. This could happen by performing certain activities like punch or direct impact to the hand due to which stress is placed on the metacarpal bones. As this kind of stress could be traumatic and beyond what the bone can withstand, an injury or a break in one or more metacarpals occurs. Thus, the condition is called as metacarpal fracture.2 In other words, metacarpal fracture can be termed as broken hand.
Classification and Types of Metacarpal Fracture or Broken Hand
- Metacarpal Fractures or Broken Hand can occur in any area of the bone. The neck of the metacarpal bone is generally the most vulnerable area mostly at its weakest point, which is where most of the metacarpal fractures occur. Metacarpal Fractures or Broken Hand is most commonly seen in sports such as boxing.
- The second most common type of metacarpal fracture is seen in the shaft or mid portion of the bone. This type of metacarpal fracture tends to extend into the joint and generally occurs backwards toward the wrist most commonly at the base of the thumb or the base of the fifth metacarpal. Fracture occurring at the base of the thumb is also known as Bennett’s fracture.3
- A transverse metacarpal fracture occurs near the base of the thumb resulting in the thumb to be positioned across the palm.
Causes and Risk Factors of Metacarpal Fracture or Broken Hand
Metacarpal Fractures Can be Caused Due to Several Injuries Including:
- Fall from heights.
- Metacarpal fracture caused due to sports injuries.
- One can sustain Metacarpal fracture or Broken Hand Punches or fist fights.
- Car accidents.
- First metacarpal base fracture can be caused due to punching a hard object such as a wall or due to fall directly on to a thumb.
- Fifth metacarpal fracture is the most common type of fracture though other four metacarpal fractures can also occur from punching such as in boxing. This type of fracture is known as a boxer’s fracture.
Signs and Symptoms of Metacarpal Fracture or Broken Hand
The Symptoms of Metacarpal Fracture or Broken Hand May Include:
- Pain with movement of the hand can be a symptoms of Metacarpal Fracture or broken hand.
- Typically acute pain from an impact.
- Development of swelling.
- Hand may appear deformed in case of severe and displaced metacarpal fracture.
- Numbness or pins and needles sensation in the fingers or hand can also be a sign and symptom of metacarpal fracture.
- Abnormal rotation with overlapping of the fractured digit under the adjacent digit.
Treatment For Metacarpal Fracture or Broken Hand
- Metacarpal fracture treatment is generally done by casting. Casting is generally required for about six weeks followed by gentle exercises involving various movements of the digit. Prolonged casting may sometimes result in stiffness in which case hand therapy is recommended.
- Surgery for metacarpal fracture or broken hand may be recommended in some severe cases where there are multiple fractures or open wound and fractures of the hand. Two factors play a major role in determining if surgery is warranted for treating metacarpal fracture or broken hand:
- Length of Digit: If the digit gets shortened or decreases in length due to metacarpal fracture or broken hand, surgery is recommended to restore the digit to its normal size.
- Rotation: In cases where the digit gets rotated due to the metacarpal fracture or broken hand, surgery is recommended to correct the deformity and restore the digit to its normal position.
- Rotational deformities are generally assessed by making a fist and checking if the fingers cross over each other.
- Metal implants such as plates, wires, and screws for treatment of metacarpal fracture or broken hand are used to fix the broken fragments of bone depending upon the nature and type of the fracture.
- Surgery involves risks of infection, bleeding, neurovascular injury, as well as hardware failure.
Physical Therapy for Metacarpal Fracture or Broken Hand
Physical therapy is required for all the patients to speed up the healing process and restore normal functioning of the wrist and hand following metacarpal fracture of broken hand.
Physical Therapy for Metacarpal Fracture of Broken Hand May Include:
- Joint mobilization.
- Soft tissue massage.
- Taping or bracing.
- Exercises to improve strength and flexibility.
- Activity modification and training.
- Appropriate plan for return to activity.
Exercises for Metacarpal Fracture or Broken Hand
Given below are few of the common exercises performed to improve strength, flexibility and endurance after healing of metacarpal fractures.
- Wrist Bend Exercise to Improve Range of Motion of Wrist and Hand following Metacarpal Fracture or Broken Hand: This exercise is performed by placing the forearm on a table and the wrist and fingers over the edge. Bend the wrist forwards and backwards slowly until a mild to moderate pain-free stretch is felt. Repeat 10 times ensuring there is no exacerbation of symptoms.
- Hand Open and Close Exercise to Improve Strength in Wrist and Hand Following Metacarpal Fracture or Broken Hand: Make a tight fist curling the fingers and the thumb. Straighten the fingers gently as far as possible until a pain-free stretch is felt. Repeat 10 times ensuring there is no exacerbation of symptoms.
- Finger Adduction to Abduction Exercise to Improve Range of Motion of Wrist and Hand Following Metacarpal Fracture or Broken Hand: Start this exercise by straightening the fingers and joining them all together. Stretch the fingers apart as far as possible until a pain-free stretch is felt. Repeat 10 times ensuring there is no exacerbation of symptoms.
- Tennis Ball Squeeze Exercise to Improve Strength in Wrist and Hand Following Metacarpal Fracture or Broken Hand: This exercise involves holding a tennis ball in the hand and squeezing it as hard as possible ensuring comfort without pain. Hold for 5 seconds and release. Repeat 5 to 10 times ensuring there is no exacerbation of symptoms.
Investigations for Metacarpal Fracture or Broken Hand
A complete subjective and physical examination is necessary to diagnose a metacarpal fracture. A thorough neurovascular examination of the hand and the digits is performed to assess for injuries to the nerves and vessels. Typically an x-ray is required for confirming the severity.
Other Diagnostic Tests May Include:
- CT Scan.