Managing metacarpal fractures

Thirty percent of fractures involve the hand with the same proportion involving the metacarpal. Most are treated nonoperatively with the emphasis being on achieving restoration of function for the individual. Biomechanically the index and middle fingers contribute to the central stable section of the hand with the other metacarpals including the thumb forming the mobile units. Fracture angulation, shortening and rotation are poorly tolerated in the fixed metacarpals and may require surgical intervention. Intra-articular fractures in the metacarpal head are relatively uncommon but often are associated with significant soft tissue damage or open injury. Like the more common intra-articular fractures at the base of the metacarpal, restoring large fragments back in place is the key for long term outcome and stability of the involved joint. Open injuries require thorough debridement and procedures to achieve appropriate skin cover. Involvement of specialists in hand therapy and surgery at an early stage is important in order to get those with metacarpal fractures, who are often young, back to function and employment.