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Metacarpal fracture fixation
Metacarpal fracture fixation is a surgical procedure that stabilises a broken (metacarpal) bone in the hand using plates and/or screws, or wires, to hold the fragments in correct alignment while they heal. It is most commonly used when a metacarpal fracture is displaced, unstable, or unlikely to heal properly with splinting alone, restoring hand strength and function.
At a glance
Anaesthetic
Commonly general anaesthetic
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately one week after surgery
Driving
Not until you can grip the wheel strongly and safely control the vehicle; varies by fixation method and hand dominance
Post Operative Hand Therapy
Required - for splinting, range of movement exercises, scar management
Splinting
Yes - splint worn while healing; duration and type depend on the fracture pattern and fixation method used
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Usually 6-8 weeks for K-wire removal and ORIF fractures; light duties earlier if desk-based
Surgical fixation of a broken metacarpal bone
Metacarpal fracture fixation is surgery to realign and stabilise a broken metacarpal bone (one of the long bones in the palm) when the fracture is displaced, unstable, or involves the joint surface.
Who is this procedure for?
- People with a displaced or unstable metacarpal fracture, where the bone fragments have shifted out of position
- People with an intra-articular metacarpal fracture (involving the joint surface) displaced by more than 1mm
- People whose fracture pattern (such as a Bennett's or Rolando fracture at the thumb base) is inherently unstable
- Not needed for stable, undisplaced fractures, which are usually treated with splinting, taping or casting alone
What does the surgery involve?
Depending on the fracture pattern, surgery may involve closed reduction and casting (“GAMP”), closed reduction with temporary K-wires passed through the skin to hold the fragments in position, or open reduction and internal fixation (ORIF) using wires, screws, or a plate and screws to hold the bone solidly while it heals. The Bouquet technique (internal wires within the medullary canal) is used for certain fracture patterns. Dr Tomlinson will recommend the method best suited to your specific fracture, occupation and hand use.
Alternatives to surgery
Surgical fixation is one option for a metacarpal fracture. Depending on your situation, the alternatives may include:
- Splinting, taping or casting alone: appropriate for stable, undisplaced fractures, which generally don’t require surgery
- Closed reduction (GAMP) alone: manipulation under anaesthetic without wires, suitable for some displaced but reducible fractures, though not commonly effective for metacarpal fractures as the bones can be difficult to hold in position
- A different fixation method: K-wire versus ORIF versus Bouquet technique – the choice depends on the specific fracture pattern
What happens if left untreated: a displaced fracture is likely to heal with shortening, angulation or rotation, causing functional problems and, for intra-articular fractures, a higher risk of post-traumatic arthritis.
Dr Tomlinson will discuss which options suit your specific fracture at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves and the fixation method used. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical – heavy lifting, manual labour or “on tools” – you’ll usually need longer, until around 6-8 weeks. Dr Tomlinson will give you advice tailored to your job and fracture at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated and how, whether you’re wearing a splint, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications.
You need to be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for six weeks after surgery for a fractured metacarpal.
When can I do a full day of administrative or desk work?
Often from 1 week after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication – your anaesthetist will give you specific instructions. (If your procedure is under local anaesthetic only, fasting is generally not required, but please still let us know.)
How long will I need to wear a splint?
A splint is worn while the fracture heals. K-wires, if used, are usually removed at 3-6 weeks. After ORIF (which generally uses screws or a plate and screws), a splint protects the fixation while allowing early gentle movement, typically until fracture healing is confirmed on an imaging at around 6 weeks.
Will I need to see a hand therapist afterwards?
Yes – hand therapy is required for splinting and for range of movement exercises and scar management. Early movement of the fingers helps prevent stiffness from scar tissue forming in the tissue planes used during surgery.
What pain medication will I need afterwards?
Often simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Stiffness of the finger or hand from tendons adhering to the fracture site or hardware
- Malunion or nonunion of the fracture
- Infection at a pin site (if wires are used) or around a plate
- Irritation from hardware, sometimes requiring a further procedure to remove it
- Injury to a nearby tendon or nerve during fixation
- Fracture (additional)
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time.
First week
Keep the dressing dry and intact until your post-operative review. You may move any joints that are not immobilised within a splint. However, you must not lift objects greater than 300 grams in weight with your fractured hand. Take paracetamol and ibuprofen as required for discomfort. You should find that your discomfort lessens and your range of movement improves each day.
Second week
K-wires, if used, remain in place and the finger must not be moved to avoid bending or breaking the wires. After ORIF, guided movement is encouraged early to reduce stiffness, under the direction of your hand therapist. Your hand therapist and surgeon will provide you with individualised instructions on wound care, splinting, range of movement exercises and loading.
6 weeks
Strength, movement and function vary at 6 weeks depending on the fracture pattern, treatment and bone healing. If your x-ray shows satisfactory bone healing you will be permitted to remove your thermoplastic splint and return to usual activities. Full strength of your bone and of your muscles is expected to return in the subsequent weeks. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
Most people are able to commence full activities at 6-8 weeks. K-wires are removed at 3-6 weeks; plates and screws are not routinely removed. Occupational demands determine how quickly you can return to heavy manual work and high risk sporting activities.
Want to know more about Metacarpal Fracture Fixation?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.