Metacarpal fractures are caused by direct or indirect trauma to metacarpal bones and account for approximately 30% of all hand fractures. Metacarpal fractures may occur at the metacarpal head, neck, base, or shaft. Because fracture of the 4th or 5th metacarpal neck most commonly occurs when a clenched fist comes in contact with a solid object, this type of metacarpal fracture is also known as a boxer's fracture. Clinical features include (e.g., pain, swelling, tenderness, reduced range of motion), incomplete grip, and, in some cases, deformity. An x-ray of the hand usually confirms a metacarpal fracture and may be used to identify associated joint dislocation. Treatment is predominantly conservative and involves reduction and immobilization. Surgical treatment is required for severe cases (e.g., open fractures, intraarticular fractures, malalignment). Complications include permanent deformity, osteoarthritis, and reduced grip strength.
Epidemiological data refers to the US, unless otherwise specified.
- Direct or indirect trauma to the metacarpal bones; (e.g., a fall, striking a firm object with a clenched fist, forced hyperextension or rotation of the joints)
- Fatigue fractures in rare cases (e.g., stress injuries in athletes, occupational injuries due to repetitive strain)
- Common mechanisms of injury
- Anatomical location
- Type of fracture: transverse, oblique, spiral, comminuted (see “ ” in “ ”)
First metacarpal fractures
- Type I metacarpal base fracture (Bennett fracture-dislocation)
- Type II metacarpal base fracture (Rolando fracture)
- See “ ” in “ .”
- Pain, swelling, and tenderness at the site of the affected metacarpal
- Reduced range of motion at the carpometacarpal (CMC) and metacarpophalangeal joints
- Palpable or visible bone and/or joint deformity
- Angulation (mostly dorsal angulation → loss of the knuckle contour and/or pseudoclaw deformity)
- Malrotation → digital overlap
- Concomitant injuries
The management of the affected bone/joint is determined by the type and severity of the deformities that are present (e.g., displacement, malrotation, shortening).
- Definitive diagnosis typically requires three radiographic views: anteroposterior, lateral, and oblique
- Additional radiographic views for specific injuries
- 1st metacarpal fractures
- 2nd–5th metacarpal base fractures
- CT: only indicated for severe fractures, CMC joint dislocation, and intraarticular fractures with bone fragmentation
- Musculoskeletal ultrasound: may be performed in linear areas of bone (e.g., diaphysis/metaphysis of the metacarpals)
- See “ ” in “ .”
- Ensure concomitant injuries and/or infections are also treated.
Conservative treatment 
- Treatment options
- Closed reduction, if necessary
- Immobilization for approx. 4 weeks, depending on physical examination findings
Surgical treatment 
- Treatment options: fracture fixation with K-wires, interfragmentary screws, or mini plates
- Permanent deformity (e.g., malrotation, misalignment, bone reduction)
- Reduced grip strength
- Joint stiffness
- Recurrent joint dislocation
We list the most important complications. The selection is not exhaustive.