The metacarpals are the bones that fold the mid portion of the hand. They are often injured in falls and/or when the patient strikes an object, such as punching a wall in anger. Metacarpal fractures are evaluated by the physician, both through physical examination and x-ray. It is critical to evaluate the swelling and deformity in the hand as well as the rotation of the fingers on making a fist. If there is a rotational deformity of the fingers, i.e., overlapping of one finger over another, then surgical intervention is warranted. X-rays help to assess the fracture pattern of the metacarpal. If the fracture is non-displaced and/or not causing significant deformity and/or functional problems, then conservative management can be instituted. Typically, this is done with a custom made orthosis splint to protect the fracture for approximately 3to 4 weeks and then a period of early mobilization follows.
If the fracture, however, is displaced and/or gives functional impairment to the hand, then consideration for surgical intervention is warranted. Again, this can be done under regional block anesthesia on an outpatient basis. Fixation devices for metacarpal fracture include those of pins, which are usually removed in approximately 4 to 5weeks, screws and/or plates which would be permanent in nature. With pin treatment, the therapy for the hand begins after removal of pins. With screw and/or plate placement, which affords greater stabilization of the fracture, therapy can begin within a few days subsequent to the surgical procedure as long as the patient is protected in a removable orthosis. Therapy is critical in an effort to stave off complications from these fractures which include stiff joints and adhesions and/or build up of scar tissue around the respective tendons which can inhibit finger motion.