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Fracture of metacarpal bones: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
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Metacarpal fractures account for 2.5% of all skeletal bone injuries.
It should be noted that the mechanism of injury, the nature of the fracture and the type of displacement of damage to the first metacarpal bone differ from fractures of the second to fifth metacarpal bones, so there is a need to consider these nosological forms separately.
ICD-10 code
S62.3. Fracture of other metacarpal bone.
What causes metacarpal fractures?
They occur mainly as a result of a direct mechanism of injury (a blow to the hand or a blow to the hand on a hard object), but can also occur with indirect application of force (axial load, bending, twisting).
Symptoms of a Metacarpal Fracture
Patients complain of pain at the site of injury and limited function of the limb.
Diagnosis of metacarpal fractures
Anamnesis
The anamnesis indicates trauma.
Inspection and physical examination
During examination, significant swelling of the back of the hand and a bluish color due to a bruise are determined. When the hand is clenched into a fist, the convexity of the head of the metacarpal bone disappears when its body is fractured. Palpation of the broken bone is painful, sometimes displaced fragments are palpated (in the form of a step). A positive symptom of axial load - pressure on the head of the metacarpal bone or on the main phalanx of the finger along the long axis causes pain at the site of the suspected fracture. Movements in the joints of the hand are limited, the grasping function is sharply impaired.
Laboratory and instrumental studies
The diagnosis is confirmed by radiography of the hand in two planes.
Metacarpal fractures are characterized by a typical displacement of fragments with an angle open to the palmar side. Deformation occurs due to the contraction of the interosseous and lumbrical muscles. As a rule, there are no significant displacements in length and width, since the metacarpal bones are fastened with ligaments in the proximal and distal sections. However, with an oblique or spiral fracture line, displacement almost always occurs; in some cases, it is impossible to hold the fragments after alignment. As a result of direct trauma, multiple and complex multi-fragmentary fractures are possible, up to and including crushing of the hand.
[ Treatment of metacarpal fractures
Indications for hospitalization
In an outpatient setting and under the supervision of a family physician, patients with closed fractures of the metacarpal bones without displacement of fragments, with transverse fractures of one or more bones, with angular deformity are treated.
10-15 ml of 1% procaine solution is injected into the fracture site. After waiting 5-10 minutes, manual reposition is performed. The assistant applies traction to the fingers. The surgeon presses on the dorsal surface at the fracture site, displacing the fragments to the palmar side, and simultaneously presses on the head of the broken metacarpal bone, trying to displace it to the back. Such actions eliminate the displacement of fragments at an angle. The limb is fixed with a dorsal plaster splint from the upper third of the forearm to the heads of the metacarpal bones, capturing the finger articulating with the broken bone (for 4 weeks).
X-rays are taken after repositioning and at the end of the fixation period. If the fracture has healed, they begin to develop movements in the previously immobilized joints. Working capacity is restored in 5-6 weeks.
In all cases of complex metacarpal injuries (multiple fractures of the II-IV metacarpal bones, as well as fractures with displacement) or when the success of treatment in a polyclinic setting is in doubt (unstable fractures), patients should be referred for inpatient treatment. Inpatient treatment can include skeletal traction, compression-distraction osteosynthesis, and various surgical interventions.
Conservative treatment of metacarpal fractures
Treatment of metacarpal fractures can be conservative and surgical. In conservative treatment, closed manual reposition is performed after anesthesia of the fracture sites with a 1% procaine solution, 5-7 ml at each point. An assistant applies traction to the fingers. The surgeon presses on the dorsal surface at the fracture site, displacing the fragments to the palmar side, and simultaneously presses on the heads of the broken metacarpal bones, trying to displace them to the back. The limb is fixed with a dorsal plaster splint from the upper third of the forearm to the fingertips. The period of permanent immobilization for single fractures is 4 weeks, for multiple fractures - 4-5 weeks, then for 2-3 weeks the limb is fixed with a removable splint.
In oblique and spiral fractures, when secondary displacement of fragments easily occurs, skeletal traction is used for the terminal phalanges.
Surgical treatment of metacarpal fractures
Surgical treatment consists of open reposition and fixation of fragments. A plaster splint is applied for 4 weeks.