Metacarpal Fractures

Hand-related trauma is a common injury accounting for nearly a million emergency department visits annually. Fractures involving the metacarpals comprise approximately 40% of all hand injuries. Sports-related injuries are seen most often in children and young adults; middle-aged workers suffer more motor vehicle accident or work-related/industrial injuries; and the elderly seems to injure their hands from ground-level falls. The most commonly reported hand fracture involves the fifth metacarpal neck. Metacarpal fractures are described by their bone location in which they occur (head-neck-shaft-base). Fracture patterns are referred to as transverse, oblique (short/long), or comminuted based on fracture line configuration. The predominance of metacarpal fractures is closed injuries. However, open metacarpal fractures can result from severe bone and soft-tissue trauma caused by bone fragment(s) lacerating the skin. Small finger metacarpal neck fractures have the highest probability of being associated with an open fracture because of their injury mechanism. The primary goals of metacarpal fracture treatment are to achieve acceptable alignment, stable reductions, bony union, and full motion. Bone fracture location, fragment(s) size, and fracture pattern will influence treatment decisions. Most metacarpal fractures can be treated nonoperatively with closed reduction maneuvers and splinting. Metacarpal fractures associated with open injuries can be treated effectively with early detection, copious irrigation, antibiotic therapy, appropriate wound coverage, and fracture immobilization. Surgical considerations of metacarpal fractures include malunion, failure to maintain fracture reduction, polytrauma, and open fractures resulting in severe soft-tissue trauma.