Hand fractures are common injuries and most involve one of the five metacarpal bones. These bones connect the wrist to the fingers and thumb and play an important role in grip strength, hand function and finger alignment. Whilst many hand fractures heal successfully without surgery, some require an operation to restore the normal position of the bones and prevent long-term problems.
Mr Robert Farnell is an experienced specialist Consultant Orthopaedic Hand and Wrist Surgeon who has been working in Leeds for over 25 years. He exclusively treats conditions affecting the adult hand and wrist, including hand fractures, finger fractures, tendon injuries and complex hand trauma.
What is a hand fracture?
A hand fracture is a break in one of the bones of the hand. Most fractures involve one of the five metacarpal bones, which extend from the wrist to the base of each finger and the thumb.
The location and severity of the fracture determine the most appropriate treatment and whether surgery is required.
How do hand fractures occur?
Metacarpal fractures most commonly occur following:
- A fall onto the hand
- Punching a hard object or another person
- Sporting injuries
- Crush injuries
- Workplace accidents
A fracture involving the neck of the fifth metacarpal is commonly known as a Boxer's Fracture.
Symptoms of a hand fracture
Symptoms usually develop immediately after the injury and commonly include:
- Pain over the injured bone
- Swelling of the hand
- Bruising
- Pain when moving the fingers
- Reduced grip strength
- Difficulty making a fist
Sometimes the injured finger rotates. When making a fist, the finger crosses over the adjacent finger instead of pointing towards the scaphoid. This is known as rotational deformity and usually requires treatment because it significantly affects hand function.
How is a hand fracture diagnosed?
Diagnosis begins with a careful clinical examination together with X-rays of the hand.
The X-rays confirm:
- Which metacarpal has been fractured
- Whether the fracture has moved out of position
- Whether the fracture extends into a joint
- Whether surgery is likely to be required
Occasionally further imaging such as a CT scan may be recommended for more complex injuries.
Find out what to expect at your outpatient appointment.
Treatment for hand fractures
Treatment depends on the position of the fracture, the stability of the bone and whether finger alignment has been affected.
Non-surgical treatment
Many metacarpal fractures require little specific treatment and are managed similarly to a soft tissue injury.
Treatment may include:
- Neighbour strapping (buddy strapping) the injured finger to the adjacent finger
- A bulky supportive bandage
- A removable splint
- A short period in a cast where necessary
Early finger movement is encouraged wherever possible to reduce stiffness and help restore normal hand function.
Surgical treatment
Some fractures require surgery. This is more likely when:
- The fracture is significantly displaced
- The finger is rotated
- The fracture is unstable
- The fracture extends into a joint
- Several fractures are present
Surgery is usually performed under either regional or general anaesthesia as a day case procedure.
Several techniques are available depending on the fracture pattern. These include:
- Smooth wires (K-wires)
- Metal plates and screws
- Occasionally specialised intramedullary fixation devices
Where plates and screws are used, the fracture is held securely enough that finger movement can usually begin immediately after surgery and a cast is often unnecessary.
Recovery after a hand fracture
Healing of the bone usually occurs within approximately six weeks, although recovery of strength and movement continues for several months.
Maintaining finger movement during recovery is particularly important. Hand therapy or physiotherapy may occasionally be recommended, especially following surgery or more complex fractures.
Read more about post-operative care.
Possible complications
Most hand fractures heal without significant problems. Potential complications include:
- Finger stiffness
- Reduced grip strength during recovery
- Rotational deformity if the fracture heals in an abnormal position
- Malunion, where the bone heals in an imperfect position
- Tendon adhesions after surgery causing reduced finger movement
- Infection following surgery (uncommon)
Prognosis
The majority of metacarpal fractures heal successfully and normal hand function is expected.
It is common for the injured knuckle to appear less prominent after healing. Although this change is usually permanent, it rarely affects hand function or grip strength.
Patients who undergo surgery will have a permanent scar. Occasionally the tendons can adhere to the scar tissue, causing some finger stiffness, although this often improves with hand exercises and rehabilitation.
Broken your hand?
If you have sustained a hand injury and think you may have broken one of the metacarpal bones, Mr Robert Farnell can assess your injury and advise whether splinting or surgery is the most appropriate treatment.
Hand Fracture FAQs
What is a Boxer's fracture?
A Boxer's fracture is a fracture of the neck of the fifth metacarpal bone, usually caused by punching a hard object.
Do all hand fractures need surgery?
No. Many metacarpal fractures heal successfully with splinting, strapping or a short period of immobilisation.
When is surgery recommended?
Surgery may be recommended for displaced, unstable or rotated fractures, fractures involving a joint or multiple fractures.
What is rotational deformity?
Rotational deformity occurs when an injured finger crosses over an adjacent finger whilst making a fist. This usually requires correction because it interferes with normal hand function.
How long does a hand fracture take to heal?
Most metacarpal fractures heal within approximately six weeks, although recovery of movement and strength continues for several months.
Will my knuckle look different afterwards?
Yes. Following some metacarpal fractures, particularly Boxer's fractures, the injured knuckle may appear less prominent. This rarely causes any functional problems.
Will I need physiotherapy?
Some patients benefit from hand therapy after more complex fractures or surgery, although many recover well with home exercises.