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Hand Fractures (Metacarpal and Phalangeal)
Understanding broken bones in the hand, including the metacarpals and the finger and thumb bones, and how they are treated.
What are phalangeal and metacarpal (hand) fractures?
A hand fracture is a broken bone (a fracture and a broken bone are the same thing) involving either the metacarpals, the long bones that form the palm, or the phalanges, the smaller bones that make up the fingers and thumb. These are among the most common fractures seen in a hand surgery practice.
A fracture may
- be undisplaced, or displaced (minimally, mildly, moderately or markedly)
- involve the joint surface (‘intra-articular’)
- involve ligamentous attachments
- be stable, or unstable
- be associated with a dislocated joint (‘fracture dislocation’)
- have rotation of a digit or angulation at the fracture site
- result in shortening of the bone due to overlap of the two broken ends
The precise nature of the fracture influences the recommendations for treatment, but so does how the individual uses their hand, and their age and general health.
Hand Fractures (Metacarpal and Phalangeal) at a glance
What is it?
A broken bone in the hand, involving the metacarpals or the phalanges
Common symptoms
Pain, swelling, bruising and deformity, with difficulty moving or using the finger or hand
Who it affects
Anyone, commonly from falls, sporting injuries, punching injuries or crush injuries
Is it serious?
Most heal well, but rotation or angulation left untreated can cause a crooked or weak finger
Treatment options
Splinting for stable fractures, or surgical fixation for displaced or rotated fractures
First step
An examination and x-ray to assess the fracture pattern and alignment
Symptoms and how phalangeal and metacarpal (hand) fractures present
The main symptoms are pain, swelling, bruising and deformity, along with difficulty bending or straightening the affected finger. A fracture with rotation can be noticed by making a loose fist and checking that all the fingers point towards the same area of the wrist, rather than crossing over one another.
An x-ray is an important investigation step for hand fractures. Many individuals remark that they didn’t realise they had a broken hand because the hand was only sore when they moved it. This is fairly standard for a hand fracture, particularly after the first 48-72 hours when the swelling and bruising starts to settle.
Causes and risk factors for metacarpal and phalangeal (hand) fractures
- Falls
- Sporting injuries
- Punching injuries
- Crush injuries
- Direct blows to the hand
How are metacarpal and phalangeal (hand) fractures diagnosed?
Diagnosis is based on x-ray, and examination, including checking for rotation and angulation of the finger.
Treatment options for metacarpal and phalangeal hand fractures
Many simple, well-aligned fractures heal well with splinting with a custom thermoplastic splint made by a hand therapist, or buddy taping to a neighbouring finger, followed by early movement to reduce the risk of stiffness.
Fractures that are displaced, rotated, angulated, or involve the joint surface often need surgical fixation with wires, screws or a plate with screws to restore alignment and allow safe early movement. Determining the most appropriate treatment requires consideration of the fracture, and the patient.
The image on the right shows a medical illustration of a plate and screws applied to a fourth metacarpal, which is commonly performed for an unstable and/or displaced shaft fracture.
When to see a hand surgeon about a fractured metacarpal or phalanx
Any suspected or confirmed hand fracture should be assessed promptly, particularly if there is visible deformity or rotation of the finger. If surgery is clearly appropriate then prompt hand surgeon review facilitates surgery within the desirable first 2 week window.
What to expect at your Hand Fracture (Metacarpal and Phalangeal) appointment
At your appointment, Dr Tomlinson will examine your hand for rotation and deformity and arrange an x-ray. Together you will discuss whether splinting or surgery is the right treatment for your specific fracture.
If traveling to see a hand surgeon in person is challenging you may wish to consider our Melbourne Hand Surgery’s Online Fracture Assessment. This is a rapid-access virtual assessment clinic for adults and children aged 10 and over with a recent, new hand fracture – including fractured fingers, thumbs, metacarpals, and carpal bones.
Frequently Asked Questions
What is a hand fracture?
A hand fracture is a broken bone involving either the metacarpals, the long bones that form the palm, or the phalanges, the smaller bones that make up the fingers and thumb. These are among the most common fractures seen in a hand surgery practice. The precise nature of the fracture influences the recommendations for treatment, along with how the individual uses their hand, and their age and general health.
What causes it?
Hand fractures commonly result from falls, sporting injuries, punching injuries, crush injuries, or direct blows to the hand.
What can I do myself?
Any suspected or confirmed hand fracture should be assessed promptly, particularly if there is visible deformity or rotation of the finger. Many people don’t realise they have a broken hand at first, since it may only be sore when moved, particularly after the first 48 to 72 hours when swelling and bruising start to settle.
What can a hand therapist do?
Many simple, well-aligned fractures heal well with splinting using a custom thermoplastic splint made by a hand therapist, or buddy taping to a neighbouring finger, followed by early movement to reduce the risk of stiffness.
What can a hand surgeon do?
Dr Tomlinson will examine your hand for rotation and deformity and arrange an x-ray. Fractures that are displaced, rotated, angulated, or involve the joint surface often need surgical fixation with wires, screws, or a plate with screws to restore alignment and allow safe early movement.
What can I expect from treatment?
At your appointment, Dr Tomlinson will examine your hand for rotation and deformity and arrange an x-ray. Together you will discuss whether splinting or surgery is the right treatment for your specific fracture. If travelling to see a hand surgeon in person is challenging, the practice also offers a Melbourne Hand Surgery’s Online Fracture Assessment, a rapid-access virtual assessment clinic for adults and children aged 10 and over with a recent, new hand fracture.
What happens if it's left untreated?
Most hand fractures heal well with appropriate treatment, but rotation or angulation left untreated can cause a crooked or weak finger. If surgery is clearly appropriate, prompt hand surgeon review helps facilitate surgery within the two week window in which fixation is generally most straightforward.
Related conditions and treatments
Fractures further up the arm at the wrist are covered separately, see distal radius fractures and scaphoid fractures. Mallet finger injuries may involve an intra-articular fracture of the distal phalanx, or may only involve the extensor tendon.