Diagnosis of a metacarpal fracture

The treating physician (for example first the family doctor, or as a specialist an orthopedic surgeon/accident surgeon) asks what happened and which symptoms were noticed. He or she will examine the affected hand and pay particular attention to a wound with visible bone, bone rubbing, step formation at the corresponding location and abnormal mobility. Always check the blood circulation, movement and strength as well as the feeling of the fingers in order not to overlook any damage.

To confirm the suspected fracture and to know more precisely where the fracture is located, an X-ray of the hand is taken in two planes. The interpretation of the x-rays allows the diagnosis of a metacarpal fracture and how the broken bone ends relate to each other. If the findings remain unclear, computer tomographic imaging (CT) may also be necessary. If there is a suspicion that soft tissues such as muscles are also severely injured or that a nerve or vessel is also affected, magnetic resonance imaging (MRI) may be helpful.

Therapy of a metacarpal fracture

Depending on the findings, the most suitable therapy is selected. This also depends on the age and other condition of the patient: If there are other, more serious injuries, these may have to be treated first. There are patients who should not be operated on, as other diseases carry too high a risk when using anesthesia.

In children, there is a tendency not to operate – since the child’s skeleton is not yet mature, it is better able to “repair itself”. Otherwise, fractures that lie outside a joint and are near one end of the bone are treated with a forearm thumb cast.If the long middle part (the shaft) of the bone is broken but has not slipped, the fracture can be treated with a forearm plaster splint, which is placed on the inside of the arm. The cast must be worn for several weeks and checked regularly.

The affected hand or arm should also be spared during the treatment and all stress and other dangers should be avoided. All other fractures, which, for example, affect a joint or are strongly displaced (dislocated), are operated. Even special types of fractures are always treated surgically.

This topic might also be of interest to you: Wrist fracture and finger fractureIf the ends of the bones are not straight on each other or the adjacent joint is also affected, surgical straightening and fixation is necessary. There are also fracture types – the Bennett or Rolando fracture of the first metacarpal – which are always treated in one operation. Only the surgical intervention ensures that the fracture is just growing back together again and that adjacent joints are not restricted in their mobility later on.

A metacarpal fracture can generally be operated on under general anesthesia – but usually only local anesthesia (regional anesthesia) or an anesthesia of the affected arm (plexus anesthesia) is used. This is discussed in detail with the patient and the advantages and disadvantages are weighed up. Often this fracture is also treated in an outpatient operation, as it is not a too difficult or long procedure.

This means that one can go home the same day after a few hours of monitoring. Only for check-ups one has to come back to the clinic or practice. Through an incision in the skin, an access to the affected bone is created and it is brought back into the correct position.

This corrected position must then be fixed using osteosynthesis material such as wires or plates. If the bone parts are displaced or if there is a so-called Winterstein fracture, in which the part of the first metacarpal bone close to the body is fractured obliquely outside the joint, a Kirschner wire osteosynthesis or a mini-plate osteosynthesis is performed. If an adjacent joint is involved, a Mini-T-Plate is inserted. The so-called Bennett (fracture with dislocation of the thumb saddle joint) and Rolando (also involving the thumb saddle joint) fractures are always treated surgically, and are given an osteosynthesis variant either with Kirschner wires, a lag screw or a mini-plate.