Broken Hand

author : AMSSM

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Broken Third Metacarpal

Question from member mditfurth:

I fell on my hand and broke this bone in my hand. What kind of recovery can I expect? What workouts can I continue to do while it's healing?

Answer from Luis D. Salazar, MD
Member AMSSM

Sorry to hear you broke your hand. There are a few things to consider when one breaks a bone in the hand and some background that we have to keep in mind. The hand is made up of 5 long bones (metacarpals) of the hand, each metacarpal joins with smaller bones and joints that make up our fingers called phalanx toward the end of the hand and carpal bones (wrist bones). The 1st, 4th and 5th metacarpals form the mobile borders of the hand while the 2nd and 3rd form the “stiff” pillars of the hand. Men ages 10-29 yrs of age have the highest incidence of metacarpal injuries.

When one breaks their hand, it will depend on which bone is broken and the amount of movement if at all has been sustained as to what the treatment will be. After seeing a medical provider the exam and x-ray will help determine treatment. They will assess the skin to make sure there is no lacerations or wounds development. There will be an exam to assess that all ligaments, muscles groups and tendon connections are intact and that there continues to be normal sensation to the area of injury.

They will look at the movement of the bone, if at all, which should have less than 10 degrees of angulation for the 2nd and 3rd metacarpal and allow less than 40 degree for the 4th and 5th metacarpal.

If there is no movement or acceptable movement of the fracture, then the fracture will need to be stabilized with at first a splint with the big knuckles bent about 90 degrees to prevent shortening of other support structures. A splint or cast can be the best non-operative treatment and may require 2-4 weeks of immobilization.

Depending on location of fracture and ongoing symptoms you can begin to progress back to activity after as much as 2 weeks of immobilization. A splint will need to be continued with participation in sports activity.

X-rays are usually obtained about every 2-3 weeks until complete healing has occurred. When the 3rd metacarpal is broken routinely 2 weeks in a splint up to the forearm is recommended and then transitioned into a hand-based splint until bone healing is appreciated on x-ray.

The 3rd metacarpal being a stiff pillar of the hand tends to do better and heal quicker clinically, meaning a faster return to activity. It can get tricky with exercise such as riding a bike or pulling through the water in your training.

Running should not be affected with having this injury but putting weight on the handlebars can cause some pain at first so it is recommended to use the “areo bars” more during your recovery. Such with any injury the goal is to continue to support the injury and not necessarily push through the pain.

Swimming in the splint may be difficult and not recommended unless you are in a prefabricated water allowable material. Yet, swimming may not have as much effect on the fracture as long as entry into the water and pulling through your stroke the fingers are in an open position instead of a claw hold. You may have to play around with your hand with swimming and even consider buddy taping to the index finger or the ring finger with swimming to see which way still gives you the same feel in the pool but not the pain.

The biggest avoidance during this injury would be to keep weight lifting and contact activity to a minimum. If you have to engage in these sorts of activity your restrictions will be do what you can do in the splint.

Keep in mind that with use during the recovery phase of an injury you may need to plan and consider icing to prevent swelling and help with how the area feels. If you are unsure if the activity or training regimen you are engaging in is safe remember to talk with your physician.

Luis D. Salazar, MD

University of Kansas

Team Physician

OrthoKansas, LLC

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date: January 31, 2017