Hand Fractures

The bones that make up the hand are called metacarpals. They are less vulnerable to injury than the fingers, but are still frequently fractured. The most common causes of hand fractures are punching injuries and crushing/direct blow injuries.

The commonest hand fracture is the fifth metacarpal neck fracture, also called a 'boxer's fracture'. These usually occur when a punch is thrown, and the knuckle of the little finger hits an opponent or a hard object and breaks at a point just below the knuckle. These injuries rarely cause any long term trouble, but may change the appearance of the hand as the knuckle 'drops' when a fist is made. Treatment consists of pain relief by splintage for 2 weeks, (often by strapping the injured digit to its neighbour) then active exercises to regain movement in the stiff finger joints. Some surgeons will apply a 'moulded cast' where a plaster of Paris cast is set in such a way that the fracture fragments are supported in a near normal position until healing has occurred. Very occasionally, metal pins (called K-wires) will be inserted during an operation, then removed 3 or 4 weeks later.

When more than one metacarpal is fractured, surgery is more likely to be offered. Internal fixation with K-wires or small metal plates and screws will restore the anatomy whilst healing proceeds.

Hand fractures cause significant swelling in the hand and fingers, which must be controlled. Elevation of the hand above the elbow in a sling in the days after injury will reduce the swelling. Hand fractures can also produce stiffness throughout the joints of the affected hand. Active movement (as soon as it is allowed) is recommended. The majority of hand fractures will heal and result in normal function with no long term disability.