Metacarpal Fracture

After your cast or splint is removed, you can control pain and swelling by using ice massages for 10 to 15 minutes, three or four times a day.

A metacarpal fracture is a partial or complete break in one of the metacarpal bones that lie between the bones of the wrist and fingers. When one of these bones is fractured, there may also be damage to tendons, nerves and blood vessels.

Causes
Metacarpal fractures can occur as a result of a strong blow to the hand or stress on the bone. The injury is often linked to work-related accidents, sports and osteoporosis.

Symptoms
Symptoms may include:

• pain in the hand
• swelling and tenderness around the fracture
• deformity in the hand
• loss of feeling below the injury
• sensation of coldness below the injury.

Treatment
Immediate Care: If the skin is broken, apply a clean dressing to control bleeding. Wrap an ice pack in a towel and place it on the area to help minimize swelling. Elevate the hand above heart level and keep both hand and wrist immobilized. See your doctor as soon as possible.

Medical Care: Your doctor will discuss your symptoms and the history of the injury with you. A physical examination will be completed and X-rays will be ordered to help identify the location and extent of the break. You may also require a tetanus shot if the bone has broken through the skin.

Non-operative treatment includes setting and immobilizing the bone. Hands-on manipulation may be needed to align the bone after which a splint or rigid cast will hold the bone in place.

If the broken bones cannot be satisfactorily aligned (set or reduced) then operative treatment is usually required. This entails stabilization of the bone with pins, wires, screws or plates as well as repair of damaged soft tissues if necessary. Your doctor may use a splint or rigid cast postoperatively to immobilize the wrist and hand.

Medications
Anesthesia and muscle relaxants may be used during surgery or hands-on manipulation. Your doctor may recommend anti-inflammatory medications to control swelling and offer pain relief.

Recovery
After the cast or splint is removed, ice massages for 10 to 15 minutes, three to four times a day, will help to control pain and swelling. Your doctor will let you know when it is safe to begin gentle exercises to stretch the soft tissues. You may also be referred for hand therapy to guide your rehabilitation.

Long-term recovery usually takes about six to eight weeks. Your outcome largely depends on your health before the injury and how well you follow your doctor's instructions.

Complications
Possible complications include:

• infection
• poor healing at the fracture site
• bone shortening or deformity
• impaired sensation
• impaired blood circulation
• limited range of motion of the fingers.