Metacarpal fractures

Last updated: July 20, 2021

Summarytoggle arrow icon

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 general fracture signs (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.

Epidemiologytoggle arrow icon


Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

  • 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

Classificationtoggle arrow icon

Clinical featurestoggle arrow icon

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).

Diagnosticstoggle arrow icon

Treatmenttoggle arrow icon

The majority of metacarpal fractures can be treated conservatively.

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal Fractures: Treatment and Complications. Hand. 2013; 9 (1): p.16-23.doi: 10.1007/s11552-013-9562-1 . | Open in Read by QxMD
  2. Kozin SH, Thoder JJ, Lieberman G. Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J Am Acad Orthop Surg. 2000; 8 (2): p.111-121.doi: 10.5435/00124635-200003000-00005 . | Open in Read by QxMD
  3. Tornetta P, Ricci W, Court-Brown CM, McQueen MM. Rockwood and Green's Fractures in Adults, International Edition, 2 Volume. Wolters Kluwer ; 2019
  4. Siewert JR. Chirurgie. Springer Verlag (2006)

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 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer