What is a Metacarpal Bone?
A metacarpal bone is one of the bones of the hand that make up the palm. The hand bone most commonly broken is the Fifth Metacarpal which is at the base of the pinkie finger (see picture).
In general, this fractured bone is from punching something. Thus, it is nicknamed a “Boxer’s Fracture.” A compound fracture is a fracture in more than one area of the affected bone.
Quickcare or ER?
Diagnosis and treatment of a broken hand can be made in the clinic.
The Red flags that will send you to the ER:
- Severe pain
I have seen infections on the hand spread like wildfire. Boom! Red streaks develop up into the arm. Some people call these red streaks “blood poisoning” Actually, it is an infection in the lymphatic system that is traveling from the source of infection to the lymph nodes. In this case, it is in the axilla (armpit). Hand infections can spread quickly
Many patients end up in the ER at 2:00 am because the pain is keeping them awake. Broken bones hurt.
What will your doctor ask?
Your doctor will want to know your symptoms. Your symptoms are your description of your injured hand. It is your story.
- What the pain like? Sharp, dull, throbbing?
- Does it get worse with movement?
- Is there any numbness?
- Key point- Is the skin opened up and bleeding?
- Is there an injury elsewhere such as on the wrist or fingers?
What will your doctor look for? (Signs of a broken hand)
Your doctor will look for signs. Remember, signs are objective findings that a doctor sees on the exam.
A doctor is trained to tell if your hand is broken. A doctor is going to look for swelling. He will observe to see if there is a gross deformity or just a little bit of swelling. How to tell if your hand is broken or sprained? Your doctor will also look for a decreased range of motions of each finger. The doctor will look for any abnormality of the fingers and wrist such as snuffbox tenderness. Ultimately, your doctor should get an X-ray to confirm his suspicions. When the bone has more than one break, it is called a comminuted fracture.
Besides a bone fracture, a key point is to look for a cut at the deformity. Sometimes, during a fight, the hand can catch a tooth of the opponent. Saliva pushed into an open wound is a bad combination. A perfect set up for an infection.
What is the doctor thinking?
Usually, these are pretty straight forward. The story, though, has to jive. Too many times, someone will say that they fell and it caused this type of fracture. Wrong!! Falls will break the wrist. Hand bones are broken by punching someone or something like a wall. In my experience, it is not a common sports injury except boxing.
Many times after a Saturday night fight, a patient sobers up and notices a deformity on the hand. They say,” Doc, I fell”
Be professional. Keep a straight face.
Key is to not let an open wound get infected.
What is the treatment of a Boxer’s Fracture?
The “broken hand ” X-ray is helpful to guide the treatment. Fractures need to be immobilized. The metacarpal hand bones are not different. Initially, a splint is used. An ulna-gutter splint gives the best support for the healing process. Immobilization should help with pain and reduce swelling.
If the broken bone is really bad, it may be straightened out by pushing on it (reduction) after a median nerve block is performed. Worst-case scenario?…..surgery by a hand surgeon followed by a broken hand cast.
How long will you have this fracture?
I tell patients the broken hand healing time is 6-8 weeks.
If it angulated, it may need an orthopedic doc to perform hand surgery. But, in general, it will take up to two months to heal. Even then, there may be a slight permanent deformity. A hand therapist may be needed for those who experience continued pain.
Let me tell you a story
When Juan entered the hometown department, he got advice from everyone. Safety was, of course, the biggest concern. Since he was always the runt of the family, he took martial arts classes to get the advantage during the hand-to-hand takedowns.When he took a job in his home town, he knew one day he could encounter one of his old drinking buddies. His hope was that it would be a simple parking ticket or traffic violation.
Little did he know that he would get into a knock-down, drag-out fight …..with his own cousin. His own cousin! Luckily, Juan’s Taser and revolver stayed in their holsters. This one was mano-a-mano. After the adrenaline subsided, Juan noticed that he had pain and swelling of his hand.
In Juan’s case, the pain was local, sharp, constant and worse with movement. His broken hand was swollen. No open wound was noted.
In this case, Juan’s injury did well. He saw an orthopedic doctor (bone specialist). No surgery was required.
After 6 weeks of desk work, he was back on patrol keeping the peace.
I hope this helps
David Reyes, MD