Fractures of the metacarpal bones are encountered quite often in medical practice. As a percentage, boxer's fracture accounts for 2.5% of all hand injuries. In total, the hand has 5 metacarpal bones. They are usually counted starting from the thumb. So, the bone in the thumb is the first metacarpal, respectively, in the little finger it is the fifth.

Depending on the cause of the damage, there are several classifications. In addition to numbering, injuries can be distinguished by location, number of injuries, severity, and type.

Fracture of III-IX metacarpal bones with displacement

In particular, according to localization there are:

1. Fractures of the head of the bone. Such injuries appear in the area of ​​the metacarpophalangeal joint.
2. Cervical fractures. This type is characterized by deformation of part of the arm.
3. Damage to the body of the bone. They arise from direct influence. This type includes fractures of the 3rd and 4th metacarpal bones.
4. Fractures of the base. These lesions are located at the thickened end of the bone, which is located near the wrist.

By number of cracks There are single (damage to one) and multiple (fracture of several metacarpal bones of the hand) injuries.

By severity level- they are available with or without displacement.

By appearance they are also divided into open and closed. The first type is dangerous because the fragments damage soft tissue and come to the surface. In this case, the wound may become infected. A closed fracture does not pose such a danger.

Causes of metacarpal fractures

As for the causes of this type of injury, there are not many of them:

• domestic injuries (unsuccessful fall on your hands, or blows to the hand with something heavy);
• sports injuries (fractures received during training);
• injuries resulting from fights or physical violence.

There is also a Bennett fracture. Its peculiarity is a fracture of the first metacarpal bone along with a displacement of its base, which is why it is also called “fracture dislocation.” Boxers most often experience this type of injury.

It received this name in honor of the surgeon who first documented it.

Another common injury is a fracture of the 5th metacarpal bone. It is also called “Brawler’s turning point.” It has this name because of the nature of its appearance, namely the impact of a fist on a table or other hard surface. With this interaction, the specified bone is overloaded, and then instantly breaks.

Signs of injury

Progressive swelling is one of the symptoms of a pentacarpal fracture

How often patients see a doctor with this diagnosis is explained by the fact that the metacarpal bones are almost not protected by muscles on the outside.

Accordingly, there is not enough muscle tissue to prevent a fracture of the pentacarpal bone or any other bone located next to it. Most often, the 1st and 5th bones of the fingers are injured.

In order to quickly identify it, you need to know the symptoms:

• piercing pain in the area of ​​possible injury.
• progressive swelling;
• prepitation of fragments;
• deformation on the outside of the hand;
• severe pain when extending the fingers.

It is worth noting that if the metacarpal bones are broken in children, then displacement may not be observed. The reason for this feature is that children's ones have a slightly different structure. They are covered by an elastic membrane - the periosteum. It is this that prevents it from completely cracking.

Diagnosis of a fracture

In order to make a diagnosis, the traumatologist first of all conducts a visual examination of the limb. Also, special attention is paid to patient complaints. Next is palpation.

The final point of the examination should be an x-ray examination. It is on the basis of the image that an accurate diagnosis is made and the type and complexity of the damage is determined.

How to give first aid

In case of any injury, you must go to the hospital immediately. But if for some reason the patient cannot be taken to a doctor immediately, it is possible to provide him with first aid. But this must be done with extreme caution, adhering to all the rules. Only then will the victim be able to wait for the arrival of doctors without harm to health.

In case of a fracture, the arm should be carefully secured with a bandage.

So, if a fracture is visually determined as closed without displacement, then the hand should be carefully secured with a bandage. This is done in order to prevent the debris from moving. Afterwards, you must call an ambulance and give the victim painkillers. No further action is taken until the doctors arrive.

Sometimes more complex situations occur. When the fracture is open and the displacements and ends of the bone are visible to the naked eye. Then we need to act differently. The wound should be carefully treated with an antiseptic substance. After this, cover the injury site with a sterile bandage. And again you need to wait for a specialist.

Fracture treatment

This type of injury can be treated both on an outpatient and inpatient basis. Much in therapy is determined by the complexity of the trauma suffered. So, if the fracture is closed and not displaced, then the doctor is able to manually move the bone into the correct position. Then several injections of procaine are given in the fracture area. Then, traction is carried out, placing the fragments in place and plaster immobilization.

After the reposition has been completed, the patient must have an x-ray. It helps to see the real condition and severity of the damage. How long to wear a cast? With normal fusion, complete recovery will take about a month.

But if an open fracture occurs, then it must be treated inpatiently. Treatment in a hospital is divided into medicinal and surgical.

Conservative treatment methods

Plaster immobilization

This type of therapy is carried out using local or regional anesthesia. After the limb is anesthetized, the damaged bone is pulled out and its fragments are displaced from the outside. Immobilization is carried out with a plaster splint. The hand is fixed starting from the upper third of the forearm to the ends of the fingers.

In addition, there is another traction option. It's called "skeletal traction." During the procedure, the bone is set by pulling the phalanges of the fingers. The method is used if there is a risk of another fragment displacement. An example of such damage is a subcapital fracture.

Surgical intervention

The help of a surgeon is necessary only in severe cases:

1. In case of open damage, the operation is aimed at cleansing the wound from microscopic bone fragments, mud deposits and infections.
2. If a boxer's fracture, for example, is not stable, then after placing the fragments, a pin is inserted through the phalanx.
3. If the bone breaks in several places, then fragmentation occurs. When eliminating an injury, it is important to install pins without damaging the joint.

How to remove the knitting needles after a fracture (metacarpal bone and finger fracture) :

Consequences and rehabilitation

If the fracture is noticed on time and the reposition is carried out correctly, then the damage heals quite quickly and no longer bothers you. But if there is a displaced fracture of the fifth metacarpal bone, then treatment may complicate the fracture of the bone.

In this case, installing pins cannot be avoided. After such a fracture of the metacarpal bone, the fingers often cannot bend. Consequently, the patient requires long-term rehabilitation.

Rehabilitation of the hand after a fracture of the metacarpal bone begins after removing the plaster or other bandage. In order for the restoration of the integrity of the bone to be successful, and the trauma suffered to bother you as little as possible, doctors give some advice on how to develop the hand after a fracture of the fifth metacarpal bone and those nearby.

Rehabilitation of the hand begins after removing the plaster or other bandage

So, a set of exercises:

• slowly straighten and bend your fingers;
• place the brush on a flat surface and try to lift your fingers one by one;
• make “scissors” with your fingers. That is, alternately move them together, simulating scissors.

Conclusion

Damage to the metacarpal bone is one of the most common household and sports injuries. It is characterized by varying degrees of severity and carries with it a lot of risk due to the unpredictable location of its appearance. But if you consult a doctor immediately after the injury, it is possible to fully or partially restore the functionality of the hand. Also, as soon as the pins are removed after a fracture of the metacarpal bone, you must not forget to do the exercises.

Fractures of the “neck” of the metacarpal bones, usually the second (II), and even more often the fifth (V), are sometimes called a boxer’s fracture. But an experienced boxer rarely gets such a fracture, so there is a second name - “brawler’s fracture”. The concept of the neck of the metacarpal bone is rather surgical; there is no such concept in the anatomical nomenclature. The fracture occurs at the border of the head of the metacarpal bone and its diaphysis. If we want to preserve “academicism,” then it would be more correct to call such a change subcapital. It is absolutely ignorant to call such a fracture a fracture of the head of the metacarpal bone (unfortunately, this does occur).

Mechanism This kind of fracture is clear from the name - a blow with a hand bent into a fist on a hard object. “Items” are different. Sometimes both the “cause” – a fracture of the metacarpal bone and the “consequence” – a fracture of the lower jaw come to the same emergency room.

As a rule, there is a significant “twisting” of the distal (peripheral) fragment towards the palmar side under the influence of force at the time of injury, i.e. – displacement of fragments at an angle open to the palmar side. But displacement can also occur secondarily under the influence of muscle forces. The angle between the fragments sometimes reaches 90°.

If the angular displacement is significant, hand function may suffer. The head of the metacarpal bone, shifted to the palmar side, interferes with grasping, and the biomechanics of the muscles, both flexors and extensors, is also disrupted.

What offsets are allowed? For subcapital fractures of the metacarpal bones, the following displacements are considered acceptable: for the 2nd and 3rd metacarpal bones, angular displacement is up to 15°, for the 4th – 30° and 40° for the 5th metacarpal bone. The function usually does not suffer with such displacements, and a small cosmetic defect (a slight “recession” in the projection of the head of the metacarpal bone) is hardly noticeable, and it is unlikely to bother the “scandalists”.

Symptoms (signs) of a fracture.

Pain at the fracture site. The pain intensifies with finger movements. Swelling naturally occurs, and there may be visible deformation (“recession” of the head of the metacarpal bone). When moving your fingers, you sometimes feel pathological mobility, a crunch that occurs between the fragments.

First aid consists of simple immobilization. The hand (hand and forearm) is placed on some kind of splint (it can be a board or a magazine folded two or three times), the hand is slightly extended, and the fingers are bent (you can put a wad of cotton wool or something similar in the hand). In this position, the hand is bandaged and suspended on a scarf.

It is necessary to apply cold (ice, etc.) locally.

Then you need to see a doctor (usually a trauma center). In some cases, usually with minor displacements, patients do not seek medical help. Apply cold, “protect” the hand. If you are lucky (acceptable displacements), the fracture will heal and the person will gradually return to normal life.

But it should be remembered that the results of self-medication may not be so optimistic (displacements can be not only angular, but also rotational, which, if not eliminated, will lead to serious dysfunction - see below).

Qualified help.

Diagnosis placed on the basis of clinical and radiological data. The symptoms are described above.

Radiography performed in two projections - direct and lateral. A lateral radiograph of metacarpal bone II is taken at 10-15° supination, III - in a strictly lateral position, and IV and V - at 15° pronation.

You should remember not only about angular displacements, but also rotational ones. With rotational displacement, the direction of the bent finger is incorrect; it intersects with one of the other fingers. Rotational displacements are unacceptable, since 5° rotation of the metacarpal bone leads to 1.5 cm of overlap of one finger over the other when clenching the fingers into a fist.

Normally, the tips of the fingers, when flexed, “look” at the scaphoid bone.

Treatment.

For non-displaced fractures, immobilization in a palmar plaster or polymer splint from the forearm to the proximal interphalangeal joints is sufficient (in addition to the patient, the adjacent healthy finger is usually immobilized) for 15–20 days.

The physician should attempt to reduce each displaced metacarpal fracture. Reduction (reduction) is best done under general anesthesia, since local administration of an anesthetic makes it difficult to influence the fragments. Reposition of subcapital fractures has its own characteristics. First of all, the main phalanx is bent as much as possible. After this, pressure is applied along the axis of this phalanx and counterpressure is applied to the proximal fragment from the back of the hand. Fixation of fragments with knitting needles also cannot be carried out with an extended phalanx.

Immobilization is carried out with a plaster cast or other bandage from the fingertips (victim and adjacent) to the elbow joint. The hand and fingers should be given the maximum possible (but not to such an extent that displacement occurs) functional position. Some authors (Jahss, Goldberg) recommend immobilization with the metacarpophalangeal joint bent at a right angle. But in this case, there is a danger of rigidity in the proximal interphalangeal joint, since in this position the lateral ligaments are relaxed, and as a result of their wrinkling, extension becomes impossible.

If the reposition is successful, and the displacement has not increased in control images after 5-7 days, immobilization is carried out for 4-6 weeks (according to different authors).

As practice shows, closed reduction and immobilization with a plaster cast only leads to complete elimination of displacement only in isolated cases.

If the displacement remains, but its magnitude is acceptable, the doctor is obliged to thoroughly explain to the patient the situation, possible treatment options, and the possible consequences of both conservative and surgical treatment. Without this, the doctor may subsequently find himself in an unpleasant position if the patient indicates a deformation, the possibility of which he was not warned about.

If the reduction is unsuccessful, then it is necessary to perform osteosynthesis of the head of the metacarpal bone with two thin Kirschner wires inserted through the skin to the proximal fragment or to adjacent healthy bones.

The wire can also be inserted from the proximal fragment.

The human body contains a huge number of bones, the role and importance of which we do not think about. For example, the metacarpal bones of the hand play a critical role in the natural motor capabilities of the fingers. It is quite possible to protect these bones from injury; the main thing is to know where they are located and what they can suffer from.

In the composition of the bones of the human hand, namely the hand, the metacarpal bones play an important role. These are small in size, extending from the wrist itself in the amount of five pieces, thereby forming peculiar rays.

There are five metacarpal bones on each hand. Their numbering begins with the bone that belongs to the thumb. Due to their structure and location, these bones take an active part in the motor ability of the fingers. They are involved in flexion and extension movements.

Each such bone includes:

• body;
• pineal gland

Despite their importance, these bones are easily vulnerable. They can be easily felt through the skin of the hand and are most often injured if any blow falls on the hand. Thus, the most common causes of fractures are fights and unfortunate falls. Medical statistics show that the first and fifth bones suffer the most.

Types of metacarpal fractures

Experts note that bone fractures in the hand area are most often found in men; women with such injuries are extremely rare.

Fractures are classified identically to injuries to other bones in the body:

1. The fracture is closed.
2. Displaced fracture.
3. Fracture without displacement.

An interesting fact is that a fracture of the base of the first metacarpal is commonly called a “boxer’s fracture.” This injury most often occurs in athletes, as well as in men involved in fights.

Fifth metacarpal bone and its fracture

The cause of a fracture of the fifth bone can be an unsuccessful fall on the hand, or a blow to the hand with a heavy object. A fracture itself is a violation of the integrity of the bone, which is accompanied by severe pain and swelling in the area of ​​injury. Hematomas often form, and moving the finger will cause unpleasant pain.

The most unpleasant is considered to be a displaced fracture of the 5th metacarpal bone, which will most likely require further surgical intervention. This type of injury significantly impairs the motor ability of the hand.

Fracture of the metacarpal bone is usually divided into three types:

1. At the base of the bone, which is closest to the wrist.
2. At the head of the bone, which is located in the area of ​​the metacarpophalangeal joint.
3. In the center of the bone.

As you can see, despite its small size, the metacarpal bone during a fracture requires detailed study. Further motor abilities in the hand area will depend on proper treatment and recovery.

If we talk about a displaced fracture, doctors note that most often it is not a lateral, but an angular displacement of the bone. When the metacarpal bone is displaced laterally, soft tissue interposition often occurs and the injury is accompanied by other associated injuries.

Symptoms of a fracture

Symptoms of a metacarpal fracture are identical to those of most fractures:

1. Sharp pain in the area of ​​injury.
2. Swelling and change in skin color.
3. Formation of a hematoma at the site of injury.
4. Damage to the finger (partially or completely).
5. Shortening of the little finger on the back of the hand may be observed.

A fracture of the fifth metacarpal bone will require a thorough diagnosis from the doctor. X-rays must be taken in two planes, but an MRI may often be needed to determine the level of damage not only to bones, but also to soft tissues.

In ambiguous cases, an X-ray of the healthy arm is taken in order to compare the images later and identify the main damage. At first glance, a fracture of the fifth metacarpal bone can be mistaken for a dislocation, which is why it is better to undergo an examination and not delay this issue.

Fracture treatment methods

If a normal fracture occurs, without associated complications, then treatment is carried out according to the traditional method. A plaster cast is applied to limit unwanted arm movements.

Typically, the cast is left on the arm for 4 to 6 weeks to avoid risk of re-injury. After removing the bandage, the patient feels some stiffness in movements, which is the absolute norm. It will take some time to develop and restore all the basic capabilities of the injured hand.

If a displaced fracture occurs, the doctor prescribes osteosynthesis; in other words, surgical intervention is necessary. During the operation, fragments of the fifth metacarpal bone are fixed using pins, plates or screws (depending on the complexity of the fracture and the patient’s capabilities).

The pins and screws are also removed using surgical procedures, but the plate can be left in the hand if it does not cause pronounced discomfort. Otherwise, the plate is removed, but this happens at least a year after the first operation.

It is important to note that when a cast is applied, the arm remains motionless for a long time. After the operation, the motor abilities of the hand may return within a few days.

The type of treatment required is determined only by the attending physician, based on the patient’s examination data.

Recovery period after a fracture

Any fracture requires a certain period of recovery so that the patient can feel the full motor capabilities of the injured area. A fracture of the fifth metacarpal bone is no exception in this matter.

For accelerated rehabilitation, the patient is prescribed a number of physiotherapeutic procedures and physical therapy exercises. The doctor may prescribe the use of special ointments and gels to quickly remove swelling from the hand.

Some useful exercises include the following:

1. Handling small parts or cereals, which allows you to restore fine motor skills of your fingers.
2. Unhurried, rather slow clenching and unclenching of fingers into a fist.
3. Slow circular movements with the hand.

If you carefully perform these exercises, as well as regularly attend medical rehabilitation procedures, the rehabilitation period will pass unnoticed.

Publication date: 12-12-2019

How to treat a fracture of the 5th metacarpal bone?

Why does the 5th metacarpal bone fracture? This question is of interest to many patients. A fracture is a violation of the integrity of a bone under the influence of various factors (impact, fall from a height, etc.).

Depending on the methods of obtaining a fracture, they can be divided into acquired and congenital. An acquired fracture is the result of mechanical stress, and in the presence of various diseases associated with deterioration of bone strength, a fracture can occur without the use of significant force, even during sleep. Also, a fracture is often accompanied by a deterioration in the condition of the skin and muscles, and with an open fracture, deep wounds are also formed.

Purpose and structure of the metacarpus

What can cause a metacarpal fracture? Most often, this type of injury occurs as a result of mechanical damage to the hand. These include hitting the hand with any hard object or applying great force. This type of injury is often called a boxer's fracture.

A fracture of the fifth metacarpal bone is most often acquired in a fight. The scene of the incident could also be a boxing sparring among beginners. Symptoms: severe, sharp pain in the area where the bruise is located, limited motor capabilities of the limb.

How to diagnose a metacarpal fracture

During an examination of the injured limb, medical workers observe extensive violet-bluish swelling on the hand. When a fracture occurs, the convexity of the head disappears if you clench the injured hand into a fist.

A fracture of the fifth metacarpal bone is quite painful; sometimes you can feel the displaced broken parts. If, when pressing with a finger on the main part of the phalanx, the victim experiences severe pain, then the diagnosis of a fracture of this bone is confirmed, and the ability to move the joints is sharply limited.

But to make a 100% diagnosis, it is necessary to take an x-ray of the damaged limb, which will show all possible displacements and chips in the metacarpal cavity.

When five metacarpal bones are fractured, displacement of the fractured parts of the bone at an angle quite often occurs, but, as a rule, these displacements are insignificant along their length. However, when a fracture occurs along an oblique or spiral line, displacement of bone fragments occurs in ninety percent of cases.

In case of severe injury, it is possible to receive comminuted fractures, there is a high risk of complete fragmentation of the bone, after which it can no longer be restored.

Treatment method for metacarpal fractures

In order for the damaged bone to heal quickly and correctly in the future, after an injury it is necessary to immediately contact a medical institution where you will receive the necessary medical care.

The victim is hospitalized and only under the strict supervision of a doctor is treated for a closed fracture of the metacarpal bone that is not displaced. The doctor injects ten to fifteen milliliters of a one percent procaine solution into the fracture site. After five to ten minutes, manual reposition is performed, while the assistant at the same time applies traction to the fingers on the injured hand.

The surgeon applies pressure on the dorsal surface of the fracture, displacing the broken bone particles to the palmar side, and with the other hand, at the same time, applies pressure on the head of the damaged metacarpal hand, displacing it to the rear. With the help of such actions, the resulting displacement of the fragments at an angle is eliminated.

The injured limb is then fixed in a cast, with the finger being grasped and articulated with the broken bone. After four weeks of removing the cast, a repeat x-ray is taken.

If the fracture is without any defects, you can begin exercises to develop the damaged joints. The damaged limb returns to normal working capacity after five to six weeks.

In the presence of complex injuries to the fifth metacarpal bone (a large number of fractures, as well as the presence of displaced fractures) or in the case when the bone begins to heal incorrectly, the patient is sent to hospital treatment. In treatment, the method of skeletal traction and various methods of surgical intervention are used. In treatment, conservative and surgical treatment methods can be used.

The length of time required for immobilization depends on the severity of the fracture. If there is a single fracture, then four weeks is enough, and if there are multiple fractures, then 4-5 weeks. 2-3 weeks after, it is necessary to fix the limb using a removable splint.

In the presence of oblique or spiral fractures of the metacarpal bone, when displacement of bone fragments is possible, it is necessary to use skeletal traction of the terminal phalanges for treatment.

Surgical treatment for this type of fracture consists of an operation for open reduction and fixation of bone fragments. After this operation, a plaster splint is applied to the injury site for 4 weeks.

After using conservative treatment, recovery of the damaged limb occurs in the case of a single fracture after 4-6 weeks, and in the presence of multiple fractures - after 6-8 weeks. After surgical treatment, full working capacity occurs within 5-6 weeks.

How to develop a hand after a fracture

How does rehabilitation work? In order to speed up the process of restoring the injured limb, it is necessary to exercise it several times a day every day.

1. Place your hands on the table, palms down. Then gradually raise your fingers from the table surface, each separately, and then all together.
2. Take the same position of the hands as in the previous exercise and make bringing and spreading movements with your fingers. Then make several circular movements with your fingers (each separately and all together) and your brush.
3. It is necessary to make “clicks” and clicks with your fingers.
4. You need to clench your fingers into a fist and unclench it. One finger at a time, or all at once.

The number of repetitions of exercises is from ten to fifteen 3-4 times a day. It is also recommended to finger various cereals, collect crafts from children's construction sets, and do exercises with an expander. You can also massage the muscles or resort to self-massage of the injured limb.