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Metacarpal Fractures are Common Injuries in Sports

by Gary Vitti
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Brad Botkin and Jasmyn Wimbish reported on November 1st for CBS Sports that Stephen Curry under went surgery for a second metacarpal fracture.  I have no direct knowledge of the specifics of Curry’s injury but I will try to fill you in on my experience with metacarpal fractures.

In 1999 during a preseason game in Kansas City Kobe Bryant suffered a fourth metacarpal fracture after being accidentally elbowed in the hand in the first quarter. Kobe just thought it was a bruise and in typical Mamba fashion said nothing to me and continued to play the rest of the game. After the game, when his adrenaline rush wore off he asked me to look at it. I could feel a slight drop off as I ran my fingers along the site of pain but we were in a non-NBA arena without x-ray capability and were in a rush to catch a plane home.  First thing the next morning, I sent him in for an x-ray which confirmed a fourth metacarpal fracture.

Quite often i’ve been asked: I couldn’t play if it was broken, could I? The answer to that question is, it depends on the fracture pattern but yes, it is quite possible to play with a fractured metacarpal. In Kobe’s case he continued to play and posted eighteen points, five assists and four steals in thirty minutes.

There are twenty five bones in the hand, five of them are metacarpals, one for each finger. The metacarpals are the long bones between the fingers and the wrist. They are generally injured from a fall or a direct blow from an object or an individual. The most commonly fractured are the neck of the fifth metacarpal (little finger) and the shaft of the fourth metacarpal (ring finger). The fifth metacarpal fracture, referred to as the boxers fracture is the most commonly broken bone in the hand.

Metacarpal fractures are common injuries in sports comprising of about 30% of all hand fractures. Although Stephen Curry had surgery it is important to know that many metacarpal fractures can be managed with non-operative care and immobilization as was the case with Kobe. The ultimate goal is to have a stable reduction of the fracture, a boney union and good mobilization.

Metacarpal fractures are categorized as: neck (the end towards the fingers), base (the end towards the wrist),  shaft (the area between the neck and the base) and thumb. The neck being the most common fracture site. While most metacarpal fractures heal well, there can be complications with incomplete healing of the bone (non-union) and stiffness from immobilization. Complications are highly correlated to the severity of the injury with open fractures and crushed injuries being the most difficult to treat. These fractures may present themselves with a shortening of a finger or a rotated finger which will require surgery on the metacarpal to correct the shortening and/or the rotational deformity.  Surgery may also be required if the fracture effects the joint surface at the neck or base of the metacarpal.

Non-union metacarpal fractures are rare with stiffness from immobilization being the more common adverse issue.  Surgical fixation with plates, screws, wires etc. may cause tendinous adhesions while immobilization causes tightness to joint capsules and ligaments. Whether the fracture is treated surgically or strictly with immobilization, splinting in a functional position (70 to 90 degrees of flexion) and early motion is integral for good function after the fracture has healed.

There is an important role for physical therapy with metacarpal fractures to insure good hand function. The therapist will aid in range of motion exercises, tendon gliding exercises and resistance exercises. This three pronged approach will insure a return to full function.

Healing time for a non-surgical metacarpal fracture is between six and ten weeks. Kobe
returned to play in seven weeks with a protective glove I customized with a hard pad to disperse the shock off of the fracture site.
The Golden State Warriors are reporting Stephen Curry will be out a minimum of three months. This seems conservative but it is the best approach. Most professional teams will also use bone stimulators to expedite healing.  These modalities include low-frequency pulsed ultra sound, pulsed electro-magnetic fields or extracorporeal shock wave therapy. Although the jury is still out as to the efficacy of bone stimulators, there doesn’t seem to be a down side and many insurance plans cover their use for certain fractures. I used them many time and from a non-scientific but clinical standpoint I think they are worth the effort.

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