In the metacarpal area, there are 5 metacarpal bones that connect the carpal bones to the phalanges. The entire hand is made up of 27 bones. Due to strong force during sports, an accident or a fall, a metacarpal bone fracture (medical term: metacarpal fracture) can occur.
What is a metacarpal bone fracture?
A metacarpal bone fracture is a break in the area of the five metacarpal bones. There are different bones in the metacarpal area: the transition from the metacarpal to the phalanges is called the metacarpal head, the longer area is the shaft, and the transition of the metacarpal bone that connects the carpus and metacarpal is called the base of the metacarpal. In all three areas, both open and closed fractures of one or more metacarpal bones can occur. If it is an open wound, the bone fracture and skin injury must be treated at the same time. A metacarpal bone fracture can occur in any of the metacarpal bones. The fracture causes pain, bruising and swelling in the metacarpal and often deformity due to a displaced fracture site.
Causes
Metacarpal fractures can have a variety of causes. Boxers are often affected by such fractures, but so are other athletes, especially those who must grip an object with their hand. In a fall, anyone can be affected if you fall awkwardly and break one or more bones of the metacarpal while catching yourself as you fall.
Typical symptoms and signs
- Bone fracture
- Bruises
- Swelling
- Hand pain
Diagnosis and course
An accurate diagnosis can only be made with the help of an X-ray, which is shown in different layers to be able to see how many bones are affected in the metacarpal fracture, whether the bones have shifted at the fracture site and what the fracture line is. Normally, no further examinations are necessary apart from the X-ray, because the fracture situation can be judged well from the X-ray. If a metacarpal fracture has occurred, the hand should be immobilized and cooled immediately. If treated quickly, a metacarpal fracture will heal within a few weeks. The hand must be immobilized for the time it takes to heal. If the fracture is not treated and grows together incorrectly, permanent damage can occur that can severely affect the mobility of the hand.
Complications
Due to the metacarpal bone fracture, the affected person primarily suffers from severe pain. As a rule, the hand itself can no longer be moved, resulting in restricted movement and various limitations in the patient’s daily life. Furthermore, bruising and swelling also occur in the affected region and patients suffer from severe pain in the hand. These can sometimes spread to the arm and cause unpleasant discomfort there. Similarly, nocturnal pain can negatively affect sleep and lead to sleep disturbances and further to depression. In order to avoid consequential damage or false adhesion of the bone, a visit to the doctor is necessary in any case to prevent these complaints. As a rule, the metacarpal bone fracture is healed and treated relatively easily with the help of a plaster cast. There are no particular complications. In some cases, physiotherapy measures are still necessary to completely limit the discomfort and restore the movement of the hand. However, even after treatment of the fracture, there may be disturbances in sensitivity or paralysis of the hand. The patient’s life expectancy is not reduced or limited by this condition.
When should you see a doctor?
As a rule, a fracture of the metacarpal bone should always be treated by a physician. Only those who decide to seek medical treatment can expect a full and prompt recovery. Such a fracture is usually accompanied by severe and almost unbearable pain, so that affected persons immediately consult a doctor. This allows appropriate treatment to be initiated as quickly as possible. In some cases, surgical intervention is even possible to enable healing without complications.The situation is different if there is only a hairline fracture. This is a small crack in the bone that is not as painful as an existing fracture. In many cases, affected persons do not notice such a hairline fracture at all, as it is only accompanied by a slight pain. The course of movement is only limited, so that often there is no suspicion of a fracture. The advantage: Such a crack in the bone grows together in most cases completely independently and without medical care. Thus, in such a case, a visit to the doctor is not mandatory. However, if there is a fracture of the bone, it is mandatory to visit the doctor to allow complete healing.
Treatment and therapy
A metacarpal bone fracture can be treated in a variety of ways, depending on the area affected. Head fractures or in the area around the head cannot be operated on. Rather, they are straightened and then immobilized by a cast for about 3 – 6 weeks. However, if bones are more displaced by the metacarpal fracture, surgery on the fracture is necessary to rule out future damage. Open fractures usually always require surgery because of the high risk of infection from an open wound. The healing process can be monitored with X-ray examinations. In most cases, physiotherapy can be carefully started a few days after the treatment in order to restore the mobility and strength of the hand very slowly. In most cases, the metacarpal fracture will heal within a few weeks by immobilization with a cast. Complications can sometimes arise with open fractures if the wound becomes infected or there is secondary bleeding or wound healing problems. If the fracture is well straightened or operated on, there will also be no deformity or restriction of mobility. Initially, swelling or numbness may still occur or pain may be felt when changing the weather, but this usually disappears a few months later. The mobility of the metacarpus also only gradually returns.
Outlook and prognosis
The prognosis of patients with metacarpal fractures is good in most cases. The fracture may still be visible on X-ray for a long time, although new bone tissue forms after as little as three weeks, giving the affected bone adequate stability again. As soon as the affected person no longer feels pressure pain in the fracture area, the fractured hand can and should be moved intensively but without strain. After five weeks, the patient can slowly start to put weight on the hand again, taking into account his or her own pain thresholds. If the fracture is treated quickly, it usually heals within a few weeks. However, the hand should be absolutely immobilized during the healing period. If the fracture is not treated and grows together incorrectly, long-term damage can occur, which can greatly impair the mobility of the hand. In a few cases, physiotherapy is also necessary to completely eliminate the discomfort and especially to restore the ability to move. However, disturbances in sensitivity and even paralysis of the hand may occur even after treatment. In some very rare cases, the metacarpal bone fracture does not heal as desired. The ends of the bone fracture then do not grow back together, and a “false joint” forms instead.
Prevention
In most cases, you cannot prevent a metacarpal fracture, except for certain sports. If the risk of injury is high, one should protect the areas at risk from force in the best possible way. Falls can usually not be avoided, because they happen suddenly and unconsciously, even if you are attentive. When skateboarding or inline skating, one usually wears special protective clothing as well as in some sports such as football or rugby, where players are at greater risk due to more intense physical contact in the area of the hands.
Aftercare
In most cases, the person affected by a metacarpal fracture has few, and even limited, direct aftercare measures available to him or her. For this reason, the affected person is primarily dependent on an early diagnosis so that other complications or complaints do not arise in the further course.Self-healing cannot occur, so that a doctor should always be consulted to ensure that the bones grow together properly. First and foremost, unnecessary stress on the hand after immobilization with a cast should be avoided. In many cases, physiotherapy measures are also necessary to increase the mobility of the hand again. Many of the exercises from such therapies can also be performed by the affected person in his or her own home, thus accelerating the healing process. If numbness occurs with the metacarpal fracture, it is advisable to see a doctor, as further treatment may be necessary. The condition does not usually reduce the life expectancy of the sufferer, with no further measures of follow-up care required.
Here’s what you can do yourself
A metacarpal fracture usually needs to be treated by a doctor in any case. If medical treatment does not occur, the bone may fuse incorrectly, causing pain and further complications. In case of a metacarpal fracture, a hospital must be visited immediately or an emergency doctor must be called if it is an accident. Healing of the fracture can be significantly accelerated by immobilizing and resting the hand. The affected person should refrain from strenuous activities or sports. The intake of trace elements and minerals can also have a positive effect on the growth of the bone and healing. Most patients are also dependent on therapy for this fracture. This can be started a few days after the cast is applied in order to fully restore the mobility of the hand. The patient can also perform various exercises at home. In the case of swelling or numbness, some patients are dependent on the help of other people. As a rule, relatives or friends should assist the affected person here. The patient’s life expectancy is usually not negatively affected by this injury.