What to Know About a Metacarpal Fracture

Medically Reviewed by Dany Paul Baby, MD on October 18, 2022
5 min read

We use our hands for almost every type of activity. But hands are complex, and when a part of them gets damaged, it can affect the whole hand. A metacarpal fracture is a break in one of the hand bones, making it hard or even impossible for the hand to work the way it usually does.

A metacarpal fracture is when one or more bones in the hand, called metacarpals, crack or break.

Your hands are complex. They’re composed of a collection of ligaments, muscles, joints, and bones that allow your hands to function. The bones of the hand are:

  • Phalanges. These are the bones in your fingers and thumb. Each finger has three bones, the distal phalanges, the middle phalanges, and the proximal phalanges, while your thumbs only contain distal and proximal phalanges.
  • Carpals. The carpals are the eight bones that make up your wrist. The lower row of these bones, called the proximal carpals, connect to the arm bones, while the top row, the distal carpals, connect to the metacarpals.
  • Metacarpals. The metacarpals are the bones that reach from the bottom of the fingers and thumb, the proximal phalanges, to the wrist. They make up the majority of your hand.

Metacarpal fractures are a common type of hand injury. For patients in the 18-34 age range, metacarpal fractures are the most common type of hand fracture. 76% of metacarpal fractures happen in males. These fractures are usually minor, but you may be unable to use your hand normally.

There are several different types of bone fractures. The most common types include:

  • Avulsion fractures. These fractures happen when a chunk of bone that is connected to a ligament or tendon is pulled away from the rest of the bone.
  • Comminuted fractures. These are fractures in which the bone has shattered into three or more pieces.
  • Oblique fractures. These fractures cross the bone at an angle.
  • Open fractures. These include an open wound near the broken bone. This often happens when the broken bone breaks through the skin.
  • Spiral fracture. Spiral fractures happen when a bone is broken from being twisted.
  • Stable fracture. In a stable fracture, the broken ends of the bone line up and aren’t really out of place.
  • Transverse fracture. These cross the bone horizontally.

Metacarpal fractures often happen due to a fall or hit to your hand. Falling onto your hand or knuckles or being hit with a hockey or lacrosse stick are common ways to fracture your metacarpals. Car accidents can also lead to metacarpal fractures.

One type of fracture, called a boxer’s fracture, can happen if you punch a wall or another solid object at high speed. This fracture is a break in the fifth metacarpal, the one below the pinky. 

The location of your metacarpal fracture may impact where you feel symptoms. Symptoms of a metacarpal fracture include:

  • Bruising
  • Crooked finger or a finger that overlaps another when you grip
  • Limited range of motion in your hand and fingers
  • Numbness
  • Pain
  • Swelling
  • Tenderness

Pain caused by a metacarpal fracture often worsens when you move, grip, or squeeze with your hand. This pain is usually the most severe in the first few days after the fracture happens.

An X-ray is the most common way for your doctor to diagnose a metacarpal fracture. X-rays also allow your doctor to see the severity of the fracture.

An X-ray is an imaging test that creates images using electromagnetic waves. Bones show white on X-rays, allowing your doctor to see if the bones are out of place or broken. A fracture may look like a dark crack in the bone. 

The treatment options for a metacarpal fracture will depend on the type of fracture, how severe the injury is, where in the bone the injury happened, and which metacarpal was affected. 

Non-surgical options. Fractures that do not need surgery will often still need to be immobilized. Immobilization prevents you from moving the injured area of the hand so the bones can heal properly. For a fractured metacarpal, you may need a cast or splint.

  • Casts are fiberglass or plaster. They wrap all the way around your hand and can only be removed in the doctor’s office.
  • Splints are not hard all the way around and are usually held in place by an elastic bandage. You can remove them or adjust them.

Surgical options. Some metacarpal fractures will need surgery. The most common reasons that a metacarpal fracture would need surgery include:

  • Damage to the nearby blood vessels, ligaments, or nerves
  • Fractures that reach into the joint
  • Loose bone fragments 
  • Movement of the bone pieces
  • Open fractures

Surgical options typically involve stabilizing the bone with a wire, pin, rod, nail, screw, or plate. Often this is done through a small cut over the injured bone. The surgeon will make sure the bone is aligned correctly before stabilizing it. 

In some cases, surgery may involve a bone graft. A bone graft is a procedure in which bone tissue, or even whole bones, from elsewhere in your body are used to repair an injury.  

Pain management. With severe injury or in the case of surgery, they may prescribe an opioid medication. In many cases, your doctor will recommend over-the-counter pain relievers like ibuprofen and acetaminophen. NSAID pain relievers such as ibuprofen and aspirin can help reduce swelling, but there is also some evidence that they may slow bone healing.

Infection prevention. If an injury to your hand also involves a wound, your doctor may prescribe an antibiotic to prevent bone infection. 

Generally speaking, it takes about three or four weeks for a metacarpal fracture to heal. More severe fractures may need more recovery time. Give yourself at least six weeks before trying to resume normal activities. It may take several months before your hand feels completely healed.

Kids with metacarpal injuries should avoid activities with a risk of reinjury for 6-12 weeks. This includes activities like:

  • Playing on playgrounds
  • Running
  • Sports

To aid recovery, your doctor may recommend physical therapy. This can help reduce stiffness in your hand and restore your range of motion.