Fracture of the 5th metacarpal bone of the right hand, rehabilitation. Types of metacarpal fractures and their treatment methods

The human skeleton has a mass of small and large bones. The hand is formed by small tubular bone tissues that perform special functions, which include the metacarpal bones (metacarpals). They are involved in the process of flexion and extension of the fingers and have curved shapes.

There are 5 small short bones on the palm of a person, in the area between the lower edge of the fingers and the wrist. Their numbering is similar to the serial number of the finger with which they are associated and starts from the thumb.

The metacarpal bone is conventionally divided into base, head and body. By thickened bases they are connected to each other and to the nearby carpal bones. The head is in the form of a ball with a slight convexity in the palmar part.

Types of injuries, their causes

Injury occurs as a result of an unsuccessful blow with a fist on a hard object or when falling on the hand, open palm, or when the palm is pinched between two objects. It is often called a “boxer’s fracture” because associated with this sport. Despite small size bones, fractures are distinguished according to the location of the focus. Injuries happen:

• at the base;
• in the center;
• on the head of the bone.

Among the most common types of metacarpal fractures are recognized:

• open, closed or
• with or without displacement;
• single or multiple formation of fragments;
• oblique, angular, rotational, helical contours of damage.

The most difficult and dangerous are considered to be a displaced fracture of the fifth metacarpal bone or a splintered injury.

Depending on the type of fracture, appropriate treatment methods are prescribed.

Symptoms

With a boxer's fracture, the following is observed:

• acute pain that intensifies with movement of the hand or fingers;
• swelling;
• changing the contour of the brush;
• bone deformation discernible upon palpation;
• specific sound (crunching) when moving;
• mobility in unnatural places;
• the appearance of hematomas
• inability to form a fist.

First aid

Emergency care for a fracture of the 5th metacarpal bone includes a number of measures to fully restore the functions of the hand. The patient’s subsequent life depends on its quality and accuracy.

Stages of provision:

• hand immobilization. The injured person must refrain from movements that involve the metacarpal bones;
• taking painkillers;
• To reduce hematomas formed during injury, cold is applied to the site.

Having provided the patient emergency assistance, it is necessary to transfer it to the reliable hands of doctors. Using modern means diagnostics, a traumatologist will be able to establish an accurate diagnosis and prescribe treatment.

In some cases, the patient may need surgical intervention. This occurs in complex fractures with displacement or comminuted, multiple formations of fragments. In some cases, the displaced fragment is reduced using the closed method under local anesthesia.

Immobilization of the patient at the first stage can be carried out using available means. A magazine, book or board of appropriate size is suitable for this. The injured hand itself is in an extended position, and the fingers are slightly bent. In this position, the hand is bandaged to an imaginary splint and secured to a scarf, scarf, etc.

At open fracture It is important to provide the patient with important anti-inflammatory and disinfecting procedures - treat the wound, stop blood loss, apply a sterile bandage to protect against dirt, dust, bacteria, and small foreign bodies.

Treatment

Like all fractures, injuries to the metacarpal bones require two types of treatment. The conservative method is used for simple injuries and involves applying a plaster cast to the patient. The plaster is removed after 4-6 weeks after the injury and is done only after additional, intermediate radiography. This is necessary to exclude a recurrent fracture, complicated, in some cases, by displacement.

Surgical intervention is necessary to tightly connect the fracture fragments when they are in an incomparable position and cannot heal correctly without the help of a surgeon. The doctor determines the need to remove fragments and clean soft tissues from small fragments.

The osteosynthesis used involves an operation with fixation of fragments using auxiliary means - knitting needles, screws, plates. This is necessary in cases where the bone has shifted, there is a noticeable shift in width or length, as well as its deformation at an angle.

When the central part of the bone is fractured, pins are used that are installed inside the bone. The pin is inserted into the medullary canal and left for 4-6 weeks, then, based on the diagnostic results indicating complete fusion of bone tissue, the foreign object is removed.

In some cases, fixing pins are used to connect the damaged bone. They are brought to the site of injury through punctures in the skin. Their edges protrude from under the skin or are completely submerged under it. The pins are removed after complete healing of the fracture, after a 6-week period.

Some aids are removed after a year after the injury or remain in the human body for life.

The doctor is busy determining the method of fixation and the need for surgery for the patient. Based on the indications and characteristics of the displacement of the fragment, one of the methods of osteosynthesis is selected. At severe pain felt by the patient at various stages of bone fusion, analgesics are used. Their dosage is determined based on pain intensity indicators.

Rehabilitation

After removing the cast, the patient feels some discomfort and stiffness in the movements of the hand and fingers. During this period, he needs a special set of measures for complete recovery and normalization of the functioning of the limb, its complete return to the physiological position.

One of the components of the complex is special physical therapy exercises, which are individually selected for a specific type of injury and the age characteristics of the patient’s body, his general condition health.

As a rule, a few days after surgery, mobility in the joints of the hand begins to resume. During this period, the patient begins to move his fingers. This is necessary to exclude violations of the physiological functions of the limb. A developed set of exercises under the supervision of a rehabilitation physician, selected by him exclusively for a specific patient, will help cope with injury.

An important factor in the treatment of any fracture and during the rehabilitation period is the patient’s nutrition. Calcium-containing products are fundamental at all stages of bone tissue fusion. Pharmacy vitamin complex, which includes everything essential microelements, should be in the diet of everyone who has suffered a fracture.

Consequences

Like other fractures, injuries to the 5th metacarpal bone can have complications and serious consequences. They usually arise when the patient is negligent about the doctor’s prescriptions or ignores visits to doctors. This is fraught with improper healing of the fracture, which may be caused by a lack of diagnosis initial stage or due to excessive loads on the injured hand. The result closed injury may become a pathological deformation of the bone, a violation normal functioning limbs.

With an open fracture, infection can occur and, as a result, the formation of suppuration and abscesses.

Prevention

The best prevention of fractures is careful adherence to personal precautions, adherence to safety regulations and monitoring physical activity associated with lifting weights or playing sports.

For professional athletes or those who do heavy lifting physical labor, daily training of the hands and consumption of vitamins containing elements that strengthen bones are necessary.

The metacarpal bones are located in the hand between the finger bones and the wrist bones. Fractures of the metacarpal bones usually occur due to direct impact - for example, hitting a hard object with a fist, falling on the hand. Based on location, fractures of the base of the metacarpal bone (the most proximal part, located near the bones of the wrist), the head of the metacarpal bone (near the metacarpophalangeal joints), and the diaphysis of the metacarpal bone (its middle part) are distinguished. Fractures can be either with displacement of bone fragments or without displacement.

For fractures without displacement of bone fragments, conservative treatment in a plaster cast is indicated. If there is displacement and unsatisfactory reposition (comparison of fragments), surgical treatment is necessary. This is due to the fact that such fractures can significantly affect the function of the hand (preservation of pain, decreased grip strength of the hand). Particular attention is paid to fractures of the head of the metacarpal bone, which is part of the metacarpophalangeal joint. Surgical treatment for fractures of the metacarpal bones with displacement of fragments contributes to the fastest and most complete restoration of hand function.

Conservative treatment of metacarpal fractures

Fractures without displacement are treated in a plaster cast, which is applied for 4-6 weeks. At the end of this period, control photographs are taken to evaluate the results of treatment and exclude secondary displacement of fragments. After removing the plaster cast, there may be some restrictions on movement in the metacarpophalangeal joints, which requires the development of movements with the help of special exercises and physical therapy. Conservative treatment is also possible with adequate reposition (comparison) of fragments in displaced fractures.

Surgical treatment of metacarpal fractures

If there is displacement of fragments along the length, width or angular deformation of the bone, then osteosynthesis is indicated - fixation of fragments using a plate, screws or pins. If the diaphysis of the metacarpal bone is fractured, it is fixed with a plate and/or screws; it is also possible to install a pin inside the bone . If the plate causes discomfort to the patient, it can be removed, but not earlier than after a year. However, in most cases, metal fixatives are not removed. The pin is installed intramedullary (inside the medullary canal) for approximately 4-6 weeks. This fixator is removed based on the results of a control x-ray - as the bone heals.

It is possible to fix the fragments using knitting needles through small punctures of the skin if adequate closed reposition (comparison) of the fragments is possible. The ends of the needles usually protrude above the skin, but can also be buried under the skin. These metal anchors are removed after the fracture has healed, approximately 6 weeks after placement. The main advantage of this method is the absence of skin incisions during the operation. Regardless of the chosen method of fixation, the patient usually begins to develop movements in the joints of the fingers a few days after the operation.

The final choice of osteosynthesis method remains with the attending physician, based on medical indications, the nature of the displacement of fragments, and the functional requirements for the hand.

After the operation, a plaster splint is applied for up to 2-3 weeks. Postoperative sutures (if any) are removed 14 days after surgical treatment; until this point, dressings are performed on an outpatient basis every other day. If the patient has undergone osteosynthesis with knitting needles, then dressings are done every other day for about 1.5 months. Limiting the load on the hand averages 3 months.

The average length of hospitalization for a fracture of the metacarpal bones is 5 days

Old malunion fractures of the metacarpal bones

In case of improperly healed fractures of the metacarpal bones, which bother the patient and cause inconvenience in life (pain, decreased grip of the hand, limited movement in the metacarpophalangeal joints), surgical treatment is also possible. However, in such situations, bone fixation is possible after osteotomy (disconnection) of the incorrectly fused bone.

Fractures of the “neck” of the metacarpal bones, usually the second (II), and even more often the fifth (V), are sometimes called a boxer’s fracture. But an experienced boxer rarely gets such a fracture, so there is a second name - “brawler’s fracture”. The concept of the neck of the metacarpal bone is rather surgical; there is no such concept in the anatomical nomenclature. The fracture occurs at the border of the head of the metacarpal bone and its diaphysis. If we want to preserve “academicism,” then it would be more correct to call such a change subcapital. It is absolutely ignorant to call such a fracture a fracture of the head of the metacarpal bone (unfortunately, this does occur).

Mechanism This kind of fracture is clear from the name - a blow with a hand bent into a fist on a hard object. “Items” are different. Sometimes both the “cause”—a metacarpal bone fracture—and the “consequence”—a fracture of the lower jaw—come to the same emergency room.

As a rule, there is a significant “twisting” of the distal (peripheral) fragment towards the palmar side under the influence of force at the time of injury, i.e. – displacement of fragments at an angle open to the palmar side. But displacement can also occur secondarily under the influence of muscle forces. The angle between the fragments sometimes reaches 90°.

If the angular displacement is significant, hand function may suffer. The head of the metacarpal bone, shifted to the palmar side, interferes with grasping, and the biomechanics of the muscles, both flexors and extensors, is also disrupted.

What offsets are allowed? For subcapital fractures of the metacarpal bones, the following displacements are considered acceptable: for the 2nd and 3rd metacarpal bones, angular displacement is up to 15°, for the 4th – 30° and 40° for the 5th metacarpal bone. The function usually does not suffer with such displacements, and a small cosmetic defect (a slight “recession” in the projection of the head of the metacarpal bone) is hardly noticeable, and it is unlikely to bother the “scandalists”.

Symptoms (signs) of a fracture.

Pain at the fracture site. The pain intensifies with finger movements. Swelling naturally occurs, and there may be visible deformation (“recession” of the head of the metacarpal bone). When moving your fingers, you sometimes feel pathological mobility, a crunch that occurs between the fragments.

First aid consists of simple immobilization. The hand (hand and forearm) is placed on some kind of splint (it can be a board or a magazine folded two or three times), the hand is slightly extended, and the fingers are bent (you can put a wad of cotton wool or something similar in the hand). In this position, the hand is bandaged and suspended on a scarf.

It is necessary to apply cold (ice, etc.) locally.

Then you need to see a doctor (usually a trauma center). In some cases, usually with small displacements, patients do not seek treatment. medical care. They apply cold and “protect” the hand. If you are lucky (acceptable displacements), the fracture will heal and the person will gradually return to normal life.

But it should be remembered that the results of self-medication may not be so optimistic (displacements can be not only angular, but also rotational, which, if not eliminated, will lead to serious dysfunction - see below).

Qualified help.

Diagnosis placed on the basis of clinical and radiological data. The symptoms are described above.

Radiography performed in two projections - direct and lateral. A lateral radiograph of metacarpal bone II is taken at 10-15° supination, III - in a strictly lateral position, and IV and V - at 15° pronation.

You should remember not only angular displacements, but also rotational ones. With rotational displacement, the direction of the bent finger is incorrect; it intersects with one of the other fingers. Rotational displacements are unacceptable, since 5° rotation of the metacarpal bone leads to 1.5 cm of overlap of one finger over the other when clenching the fingers into a fist.

Normally, the tips of the fingers, when flexed, “look” at the scaphoid bone.

Treatment.

For non-displaced fractures, immobilization in a palmar plaster or polymer splint from the forearm to the proximal interphalangeal joints is sufficient (in addition to the patient, the adjacent healthy finger is usually immobilized) for 15–20 days.

The physician should attempt to reduce each displaced metacarpal fracture. Reduction (reduction) is best done under general anesthesia, since local administration of an anesthetic makes it difficult to influence the fragments. Reposition of subcapital fractures has its own characteristics. First of all, the main phalanx is bent as much as possible. After this, pressure is applied along the axis of this phalanx and counterpressure is applied to the proximal fragment from the back of the hand. Fixation of fragments with knitting needles also cannot be carried out with an extended phalanx.

Immobilization is carried out with a plaster cast or other bandage from the fingertips (victim and adjacent) to the elbow joint. The hand and fingers should be given the maximum possible (but not to such an extent that displacement occurs) functional position. Some authors (Jahss, Goldberg) recommend immobilization with the metacarpophalangeal joint bent at a right angle. But in this case, there is a danger of rigidity in the proximal interphalangeal joint, since in this position the lateral ligaments are relaxed, and as a result of their wrinkling, extension becomes impossible.

If the reposition is successful, and the displacement has not increased in control images after 5-7 days, immobilization is carried out for 4-6 weeks (according to different authors).

As practice shows, closed reduction and immobilization with a plaster cast only leads to complete elimination of displacement only in isolated cases.

If the displacement remains, but its magnitude is acceptable, the doctor is obliged to thoroughly explain the situation to the patient, possible options treatment, possible consequences both conservative and surgical treatment. Without this, the doctor may subsequently find himself in an unpleasant position if the patient indicates a deformation, the possibility of which he was not warned about.

If the reduction is unsuccessful, then it is necessary to perform osteosynthesis of the head of the metacarpal bone with two thin Kirschner wires inserted through the skin to the proximal fragment or to adjacent healthy bones.

The wire can also be inserted from the proximal fragment.

The metacarpal is one of the bones of the hand. It comes out of the wrist and forms a beam and is short in length. A person has 5 metacarpal bones on one hand, they are connected to each other using joints. The main purpose of the metacarpal bones is to provide movement (flexion and extension) of the fingers.

Causes and symptoms of metacarpal fracture

Trauma manifests itself as a violation of the integrity of the bone. Damage caused by a fall heavy object on hand or strong blow fist.

This type of injury manifests itself:

• pain;
• swelling;
• impairment of hand function;
• bruising;
• visual reduction of the damaged finger.

When such a fracture occurs, the mobility of the finger is preserved. But in a limited and difficult way due to severe pain.

Types of injury

In the vast majority of cases, fractures of the first and fifth metacarpal bones occur. Bone injuries are divided into closed and open, with and without displacement.

First metacarpal fracture

This is the most common type of injury, especially in men. It occurs due to some strong impact on the bone.

There are two types of such injuries:

• Bennett's fracture - damage at the very base of the bone (inside the joint itself);
• the fracture line does not fall into the joint itself, since it is located remotely from the joint gap.

The peculiarity of this type of fracture is that in order to correctly diagnose and determine the nature of the injury, it is necessary to take an x-ray in several planes.

Diagnostics

It is easy to identify an injury by symptoms and indicative clinical picture. But sometimes a fracture can be confused with a dislocation. Therefore, only a doctor after an X-ray examination should draw conclusions, make a diagnosis and prescribe treatment.

Sometimes, to determine the nature of the injury, x-rays healthy hand to compare and make a final diagnosis. In some cases, bone CT and MRI (to assess the condition of soft tissues) are prescribed.

Treatment of a metacarpal fracture depends primarily on the nature of the injury. Next, we will consider in more detail the treatment and rehabilitation for each fracture option.

First metacarpal fracture

The most common treatment is to realign the bone under local anesthesia. Thumb stretches along the axis, and then, using force, the doctor presses on the base of the bone. After this, plaster is applied to the bone. After the plaster is removed, another photograph is taken to ensure there are no defects or distortions.

If the fracture cannot be reduced, then the doctor is forced to resort to surgery. The operation is performed under local or regional anesthesia.

The surgical intervention goes like this:

1. A small incision is made at the site of the injury to gain access to the bone.
2. The broken bone is isolated and a pin is inserted to help fix the bone.
3. The wound is sutured and a plaster cast is applied.

Damage to the body of the first metacarpal bone

Mostly such injuries occur as a result of direct impact on the fingers.

First, the doctor takes an x-ray. If the fracture is not mixed, then a plaster bandage is made. If the doctor suspects displacement, preparation is performed, and only then plaster is applied.

For splintered injuries, “Clapp traction” is performed - skeletal traction on the nail phalanx. This procedure is good when the patient has an unreducible fracture. The finger is fixed using a knitting needle.

Fracture of the second to fifth metacarpal bones

As with any other fracture, the first thing you need to do is take an x-ray of the injured arm.

For a non-displaced injury, a cast is applied for a month. In case of angular displacement, the operation is performed under local anesthesia. In case of multiple fractures, skeletal traction is used. The procedure is carried out over three or four weeks.

Re-displacement

If repeated displacement occurs, skeletal traction is performed for three weeks. In advanced cases it is recommended surgery. Using one or more wires, the fracture is fixed for 3 weeks. After removing the wires, the plaster cast remains for several weeks. The patient is prescribed physical therapy and a course of physiotherapy.

If there is a very strong displacement, then the doctor carries out a procedure for simultaneously comparing all the fragments. After this, a plaster cast is used for fixation.

Rehabilitation

The recovery program is prescribed individually, taking into account the type, nature and severity of the injury. For rehabilitation, magnetotherapy is prescribed - exposure to magnetic fields, UHF and a lamp.
If the swelling does not go away during treatment, anti-inflammatory ointments should be used.

To restore hand mobility, perform a set of general exercises:

1. To restore fine motor skills, sort through small grains. You need to mix several types of cereals, and then manually separate one type from another.
2. To develop a hand, assemble a children's construction set.
3. Exercise to bend and straighten your fingers into a fist. It needs to be done slowly - if the brush is not fully fused, it can be easily damaged.
4. Perform circular movements with your fingers.
5. To develop the hand and arm itself - exercises with an expander.

Possible complications

With poor quality or untimely treatment, the following complications are possible:

• improperly fused bones;
• limited finger movement;
• various types of infections - possibly rotting of the wound or damage to the tendon.

Serious consequences and complications are rare. If the treatment is carried out by a qualified doctor who correctly assesses the degree and type of fracture and draws up an effective recovery program, then the hand will regain its former mobility without any problems.

- a common injury. Fractures of the hand bones account for about 35% of all traumatic injuries to the skeletal system. Typically, the cause of a fracture of the hand bones is a blow to the hand or a fall with emphasis on the hand. Fractures of the hand bones include fractures of the wrist, metacarpals, and phalanges. Accompanied by swelling of the hand and pain at the fracture site. The diagnosis is made by a traumatologist based on X-ray results. Treatment consists of immobilizing the hand until the fracture site heals. According to indications, osteosynthesis can be performed. For nonunion fractures and the formation of a pseudarthrosis, arthrodesis may be required.

General information

Fractures of the hand bones are a common injury. Fractures of the hand bones account for about 35% of all traumatic injuries to the skeletal system. Typically, the cause of a fracture of the hand bones is a blow to the hand or a fall with emphasis on the hand.

Anatomy

The hand consists of 27 bones, which are divided into a group of carpal bones, a group of metacarpal bones and a group of phalangeal bones. The eight short spongy carpal bones are arranged in two rows (four bones in each row). The upper row, if you go from the 5th finger to the 1st, consists of the pisiform, triquetral, lunate and scaphoid bones, the lower row - of the hamate, capitate, trapezoid and polygonal. The three bones of the upper row of the wrist (except the pisiform) connect to the radius to form the wrist joint. The bones of the lower row of the wrist articulate with the long tubular metacarpal bones, and they, in turn, connect with the bones of the proximal (located closer to the body) phalanges of the fingers.

Classification

Wrist fractures

Treatment of metacarpal fractures

For fractures of the metacarpal bones without displacement of the fragments, fixation is performed with a plaster splint for 1 month. For displaced fractures of the metacarpal bones, reduction is performed before applying splints. If it is impossible to match and/or retain fragments, it is shown surgery with fixation of fragments with knitting needles.

Fractures of the phalanges of the fingers

Widespread hand fractures. Finger fractures occur due to direct or indirect trauma. They can be helical, splintered and transverse, intra- or extra-articular.

Symptoms of a broken finger

The finger is swollen, cyanotic, and sharply painful on palpation and axial load. Movement is limited due to pain. Deformation of the damaged phalanx is possible. To confirm a finger fracture, radiographs are taken in two projections.

Treatment of a broken finger

To preserve the function of the finger, it is very important to properly match the fragments of the damaged phalanx. For finger fractures without displacement of bone fragments, a plaster splint is applied for 3-4 weeks. For displaced finger fractures, a preliminary reduction is performed. If the fragments cannot be compared and/or held, fixation is performed with knitting needles, or less often with bone pins. In some cases, skeletal traction is applied.