The hand is usually splinted in a specific position: the wrist extended 30° and the fingers flexed about 90°, to prevents stiffness of the collateral ligaments (ligaments holding the finger and metacarpal bones together), as well as takes tension of the lumbrical muscles, which can act as a deforming force on the fracture (meaning, the pull of this muscle makes the fracture more deformed). But full activity (including sports) is typically allowed after 4-6 weeks. For bad breaks, an extra 2 weeks in a cast is needed. If the broken bone is stable, and it will stay in place with a splint, then a splint is worn for 2-3 weeks, and then removed so people can slowly start using the hand again. Nonsurgical treatment is always preferred. So which breaks need surgery? It all depends on how stable the broken hand is. A broken shaft can also rotate as described above, and this needs to be corrected also. In fact, our hand is less tolerant of a bent shaft and therefore it usually needs to be straightened. If the metacarpal shaft breaks the bone also bends forward. The pinky tolerates a greater bending deformity because its more flexible so it can compensate for being a little out of position. The ring finger can tolerate a little more bending (about 30-40°) while the pinky finger can tolerate the most (about 50-60°). Overall if the metacarpal neck breaks, the index and middle finger must be very close to normal, any bending 10-20° beyond normal needs to be straightened (either by pushing & pulling the fracture into place, or with surgery). This stuff can get complicated so we will keep it brief. The different fingers can tolerate different degrees of abnormal bending. This sometimes needs to be straightened out so that the hand heals without future problems. When it bends too far, the bone is "mal-aligned". When the bone breaks, it usually bends forward too. Some breaks need surgery, while most only need a few weeks in a splint. How is a Broken Hand (Metacarpal Fracture) treated? There are different ways to treat a broken hand, and it usually depends on how badly the bone is broken. The x-ray will show a crack in the bone, and usually the bone is also bent forward (displaced). X-rays are the best way to diagnose a broken hand. A doctor that is suspicious for a broken hand will then get an x-ray. Doctors worry about a "fight bite", meaning the knuckle can get cut against someones tooth during a punch and this causes a high risk for infection ( see hand infection talk). Doctors will look at the knuckles for any lacerations. This overlap needs to be corrected by straightening out the bone. However, if a metacarpal breaks, it can rotate out of place, which causes the fingers to overlap leading to discomfort and preventing normal grip. In a normal hand, each of the fingers stay in their “lane” and theres no overlap. Its important to evaluate the position of the fingers as they flex forward to make a fist. Examining the hand will show significant pain and swelling, usually over the knuckle. How is a Broken Hand (Metacarpal Fracture) diagnosed? People with a metacarpal fracture will report a specific incident where they injured their hand by punching something hard, or twisting their hand with great force. It’s a young persons injury, typically guys with either too much testosterone or too much alcohol. 70% of these occur in people 11 to 45 years old. Thats how they got the name the “Boxers Fracture”, which is most commonly a fracture of the 5th metacarpal (your pinky finger). Because the metacarpals form your knuckle, they are commonly broken while punching something. A base fracture is also less common, and doctors worry about joint dislocation in addition to a break when they see this. A head fracture is less common, and doctors worry about injury to the cartilage within the knuckle when they see this. A break in the metacarpal neck is the most common, but a metacarpal shaft fracture is also pretty common. The metacarpal bone is divided into regions: the head, neck, shaft and base. When they meet up with your finger bones, they form your knuckles (your knuckles are a joint in your hand that allow for finger motion). You have five metacarpals bones in your hand, one for each finger (1st is part of your thumb, the 2nd is part of your index finger, the 3rd is part of your middle finger, the 4th part of your ring finger and the 5th part of your pinky finger). A broken hand also called a metacarpal bone fracture.
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