Brief Outline of Metacarpal Fractures

Breaks or fractures in one or more of the metacarpal bones may result from a variety of events. They are common in football and basketball players. Metacarpals are vulnerable of events. They are common in football and basketball players. Metacarpals are vulnerable to direct force and can be fractured when a closed fist strikes another person or hard object, such injuries being referred to as boxer’s fracture. Metacarpal bones can fracture either at the base, shaft or neck. The most common fracture is of the neck of the fifth metacarpal.

Anatomy and physiology

The five metacarpal bones run between the wrist and the knuckles (which are the heads of the metacarpals). Each metacarpal bone comprises a base, neck and head, (from proximal to distal end). The first metacarpal bone is the shortest and most agile, and connects with the trapezium at the proximal end of the thumb. The other four metacarpals of teh hand connect to the trapezoid, capitate and hamate, and lateral-medial surfaces of metacarpal bones. Each finger has three phalanges, whereas the thumb only has two, making a total of fourteen phalanges. These connect with the heads of the metacarpals, forming the knuckles when the fist is closed.

Metacarpal Fractures


Cause of metacarpal fractures

A direct blow to the hand. Falling directly onto the hand. Longitudinal force transmitted through a closed fist when punching.

Signs and symptoms

Local pain and swelling. Bruising and deformity of the broken bone or knuckle. Loss of hand movement and function in the affected region.

Complications if left unattended

Use of hand not properly immobilised following metacarpal fracture may lead to lasting deformity and reduced function as well as possible damage to surrounding nerves, muscles, tendons, blood vessels, and ligaments.


Full recovery from most metacarpal fractures can be expected with aggressive early attention, which may include resetting of the bone and immobilisation of the hand. Surgery may be required in the case of displaced bones, with the affected metacarpal realigned and held fast by means of removable pins.

Rehabilitation and prevention

Prevention of metacarpal fractures requires avoidance of activities likely to produce them, particularly striking hard objects with the hand. Preventing further injury to already fractured metacarpals is usually accomplished by immobilising the hand, either with a finger splint or short cast, depending on the nature of the metacarpal fracture. Exercises designed to gradually increase movement, flexion, and extension of the wrist or fingers will help restore full use.

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