Hand fractures, including metacarpal fractures, involve breaks in the bones of the hand, often causing pain and swelling.
The hand contains a network of small bones, the metacarpals in the palm and the phalanges in the fingers, that can fracture from trauma. Fractures range from stable, minimally displaced injuries to more significant fractures with rotation or angulation of the bone fragments.
One pattern deserves particular attention: a rotational deformity, where the finger crosses over its neighbour when making a fist, rather than lying parallel. This can be subtle, easy to overlook on X-ray alone, and important to identify, since even a small amount of rotation noticeably affects how the fingers work together when gripping.
Hand fractures are usually caused by direct trauma: a punch (the fifth metacarpal neck, sometimes called a boxer's fracture, is a classic example), a fall onto the hand, a crush injury from machinery or a heavy object, or a direct blow during sport.
Common symptoms of a hand fracture include:
Any of these findings after a hand injury warrant assessment, and a rotational deformity in particular should be specifically checked for during examination.
Assessment includes examination for tenderness, swelling and, importantly, any rotational deformity, together with X-rays to confirm the fracture pattern and degree of displacement.
Stable fractures without significant displacement or rotation are often treated with splinting or buddy taping to an adjacent finger, alongside early, gentle motion to reduce stiffness.
Fractures that are significantly displaced, unstable or show rotational deformity generally require surgical fixation, using wires, plates or screws to hold the bone in the correct position and rotation while it heals.
Most hand fractures heal well with timely, appropriate treatment. Rotational deformity that is missed or inadequately corrected can lead to lasting difficulty with grip and finger function, which is why careful assessment for this specific pattern is emphasised. With good alignment achieved and maintained during healing, function is generally well restored.
Hand fractures are common injuries that generally heal well with appropriate treatment, whether splinting or surgical fixation. Careful assessment for rotational deformity is an important part of treatment, since even a subtle rotation can meaningfully affect grip if missed. Persistent pain, swelling or an abnormal finger position after a hand injury is worth having X-rayed.
