A Fractured (Broken) Metacarpal: What to Know

A fractured (broken) metacarpal is a common injury of the hand. A metacarpal fracture affects one or more of the five metacarpal bones that run from the wrist (carpal) bones to the knuckles. An impact injury, such as a fall or blow to the hand, is usually the cause of a metacarpal fracture.

Metacarpal fractures can take more than a month to heal. Treatment for metacarpal fractures usually includes not moving the finger while it heals, pain relief, and rehabilitation. In severe cases, surgery might be needed.

The article looks at the symptoms and causes of metacarpal fractures and explains how these common fractures are diagnosed and treated.

Metacarpal Fracture Symptoms

There is a metacarpal bone in each of your fingers and any of them can get broken. The symptoms of a fractured metacarpal will only be in the injured finger and can include:

• Severe pain that gets worse when gripping or balling your hand into a fist
• Swelling
• Tenderness
• Bruising
• Stiffness or inability to move a finger
• Numbness in your hand or fingers
• A visible deformity (e.g., visible lump or misaligned bone)
  

Causes of Metacarpal Fracture

Metacarpal fractures are commonly caused by an impact injury—when something either strikes the hand or the hand strikes something with a lot of force.

Common causes of a metacarpal fracture include:

• Hitting your hand on the ground while falling
• Sports injuries (e.g., football, basketball, hockey, boxing, and soccer)
• Getting your hand slammed in a door
• Car accidents
• Fist fights or punches
  

Diagnosis

Some metacarpal fractures can be diagnosed by having a provider look at your hand. For example, compound fractures can often be diagnosed this way because there is an open wound or break in the skin near the site of the broken bone.

The location of the fracture will help your provider figure out what the best treatment for the injury will be. An X-ray is usually used to diagnose a fracture and see what kind it is, as well as how bad the break is.

Each type of metacarpal fracture is generally described by where it’s located:

• Metacarpal shaft fracture: Break in the center of the bone
• Metacarpal head fracture: Break by the base of the finger at the knuckle
• Fractures of the base of the metacarpal: Break near the wrist bones

There are also general types of fractures that can affect the fingers, including:

• Transverse 
• Oblique
• Spiral
• Segmental
• Comminuted
• Buckle
• Hairline

These breaks can be compound, stress, or avulsion fractures.

Fractured Metacarpal Treatment

Metacarpal fractures almost always need to be put in a splint or a cast (immobilization). Not moving your finger can last anywhere from three to six weeks, depending on the severity of the break and how it’s healing.

A metacarpal fracture can be very painful. Your provider might tell you to try these remedies at home to manage the discomfort while you’re healing:

• Ice application and elevation of the hand during the early stages
• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen) for temporary, short-term pain relief
• Prescription opioid drugs like codeine for short-term relief of severe pain

Rehabilitation

After you’ve healed enough, a rehabilitation plan with a physical therapist might be recommended for a metacarpal fracture. 

Doing this therapy can help prevent complications like "wear-and-tear" arthritis (osteoarthritis), nerve or blood vessel damage, permanent stiffness, pain, or loss of hand mobility.

Surgery

There are a few situations where surgery is recommended for a metacarpal fracture:

• There is a compound (open) fracture
• A bone fragment is loose and could heal unevenly
• A bone piece moves before it heals correctly
• A bone causes a finger to rotate abnormally
• A fracture might cause a finger to get shorter
• Ligaments, blood vessels, or nerves have been damaged
• A fracture extends to a joint or the carpal bones

If surgery is needed, a surgeon may fix the broken bone with pins, plates, or screws. In severe cases, such as crush injuries, external fixation is needed. In this surgery, external hardware is attached to the bone fragments to hold them in place.

Summary

A broken finger bone or metacarpal fracture is a common but painful injury. There are different types of fractures that can affect the fingers, and different bones in the fingers can be broken.

You’ll need to see a provider to get diagnosed with a metacarpal fracture. The treatment you’ll need will depend on the break but often requires not moving your hand until the fracture heals. In some cases, you might need surgery.