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Fractures of the Palm

(Metacarpal Fractures)

By Danielle Campagne, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

Fractures of the palm involve the bones located between the finger bones and wrist bones. These bones are called metacarpal bones. Occasionally, the metacarpal bone at the base of the thumb fractures, but these fractures are usually considered separately.

  • Metacarpal neck fractures often result from punching a hard object.

  • The knuckles are swollen and tender.

  • Usually, doctors can diagnose these fractures based on x-rays taken from several angles.

  • Treatment involves a splint and sometimes first putting the broken pieces of bone back in place (reduction), depending on the type of fracture.

Metacarpal fractures are often called boxer's fractures because they result from punching a hard object (such as a wall or another person's jaw). When these fractures result from punching someone in the mouth, the skin may be broken. In such cases, bacteria from the other person's mouth can contaminate the wound and cause infections that, if not treated soon, can permanently affect use of the hand.

Symptoms

The knuckles become swollen and tender. Occasionally, the broken pieces of bone are out of place (misaligned) or rotate so that a finger is out of position.

Diagnosis

  • X-rays

If people think that they may have fractured their palm, they should see a doctor.

Usually, doctors can diagnose the fracture based on x-rays taken from several angles.

Treatment

  • Sometimes realignment of the broken bones

  • A splint

If people have wounds near the injured joint, they may have punched someone in the mouth. If they did punch someone in the mouth, doctors may clean out the wound and give them antibiotics to prevent infection.

Metacarpal neck fractures are treated with a splint (such as an ulnar gutter splint) and then a cast that is worn for several weeks. Whether the broken pieces need to be put back in place (reduced) before the splint is applied depends on the type of fracture.

Ulnar Gutter Splint

If the broken pieces are badly misaligned or rotated, doctors move them back in place without surgery—called closed reduction.

Before moving the bones back in place, doctors may use one of the following to prevent people from feeling pain:

  • A hematoma block

  • An ulnar nerve block

For a hematoma block, a needle is inserted through the skin into the fracture where blood has collected (a hematoma is an accumulation of blood). Then lidocaine (an anesthetic) is injected, numbing area around the fractured bones.

For an ulnar nerve block, doctors inject an anesthetic into nerves in the area. This procedure prevents the nerves from sending pain signals to the brain. The ulnar nerve runs from the elbow to the little and ring fingers.

After the splint is removed, exercises to move the hand and fingers through their full range of motion are started gradually. Typically, people regain full use of their hand.

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