Orthopaedics

How To Treat Metacarpal Fractures ?

The prime aim of the treatment of metacarpal fractures is to regain and maintain the good hand mechanics. So proper healing is extremely essential. The second and the third metacarpals (at the index finger and the middle finger respectively) acts as an anchor for others. So the healing is very important for these two. More angulation might be tolerated for fractures in the 3rd, 4th and 5th metacarpals. But rotation and excessive shortening must be avoided. Normal positioning must be the goal.

When surgery is done to realign the fractured metacarpals to their normal positions, it is called Open Reduction. But when surgery is not involved it is called Closed Reduction. Metal wires, pins or screws might be essential during an open reduction. These help in maintaining the position. Internal fixation can make motion in the fingers very early when physical therapy is done. The merit of open reduction is obtaining the perfect or nearly perfect results with it.

Casts, braces or splints are even used after surgery. They help in maintaining the proper position as well acting as a protection and active support for the hand. When angulation is not excessive fractures at the neck of the metacarpal, reduction is more often not required. Buddy taping may also be done where the fractured finger is taped with an unaffected adjacent finger. An athletic tape is generally used for tapping. An early initiation of motion exercises under doctor’s guidance may be done. Follow-up X-rays must be done at intervals of 5-7 days. This is done to rule out further displacement or angulation. When the fracture involves multiple pieces, an external metal device may be required. This is done to maintain the fragments at their normal positions and allowing joint motions. This device is named as External Fixator. Antibiotic treatment must be given for open wounds. following the required wound care. Massive crushing injuries on hand must be taken to hospitals to prevent infection and swelling.

Rehabilitation:

Before performing rehabilitation the type, location and time of immobilization must be taken into account. A physical therapist, occupational therapist and a hand therapist are required to administer the rehabilitation program. The prime focus of the rehabilitation is to restore the normal strength and the range of motion of the hand. The pain must be reduced and the entire normal functioning of the hand must be restored. the complete function of the thumb must be preserved. equal attention must be paid to both intrinsic and extrinsic muscles of the hand. Occupational therapy help in assisting the daily activities during the immobilization period. If a surgery is performed, then it is extremely important to perform rehabilitation techniques only as per the guidelines from an established therapist and your physician.

Bone healing takes about 6-12 weeks. But to regain the previous strength of the bones may require several years. Resuming to normal daily activities is possible once complete healing occurs. But overloading on the fracture site or even with the affected hand is not advisable until the complete strength of the hand is regained. Work restrictions vary according to the fracture severity. Accommodation is also decided on it. the patient is advise to keep the affected hand on an elevated position during the rest periods. Alternatives like speech recognition software for typing job may be used in case, hand usage is extremely needed. The thumb requires 2 weeks longer time on an average in comparison to other metacarpals to heal completely. The same is also applicable for using the thumb to grasp heavy loads.

Possible Complications:

Malunion is one of the possible complication of the metacarpal fractures. Pain is felt while gripping in this condition. Nonunion is another complication which requires reconstructive surgery. The other complications include infection (especially pin tract), intrinsic muscle contractures, metacarpophalangeal joint extension contractures, tendon adherence and refracture.

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