Overview
what it is and why it mattersThe hand has 19 bones beyond the wrist (five metacarpals and fourteen phalanges), and the tolerance for malposition is tighter here than almost anywhere else in the skeleton. A few degrees of rotational malalignment in a metacarpal translates into a finger that crosses over its neighbor when you make a fist. A joint surface left with a step-off produces arthritis in a joint you bend thousands of times a day.
Metacarpal fractures are the most common hand fractures. The fifth metacarpal neck fracture (the "boxer's fracture") is the one seen most often, usually from punching something harder than the hand. Most heal with buddy taping or a short splint because the neighboring metacarpals act as an internal splint. The fractures that need surgery have significant shortening, rotational deformity, or involvement of the metacarpal base joint.
Phalangeal fractures are common and often underestimated. Stable, non-displaced fractures do well with buddy taping and early motion. Displaced or rotated fractures, intra-articular fractures, and unstable fractures need fixation. The tendon injuries that mimic or accompany phalangeal fractures (mallet finger, where the extensor tendon pulls off the distal phalanx, and jersey finger, where the flexor tendon avulses) are just as important to diagnose correctly, because the treatment and timing differ.
Common hand fractures we treat
specific patterns within the handEach of these has its own page:
Symptoms
Metacarpal fractures present with pain, swelling, and often a visible depression over the knuckle. The key thing the doctor checks is rotational alignment, by watching the fingers as you make a fist. If one finger crosses over its neighbor, there is a rotational deformity that needs correction.
Mallet finger is distinctive: the fingertip droops and you cannot straighten it actively, though it straightens passively. Jersey finger is the opposite: you cannot bend the tip, and there is tenderness along the palm side of the finger where the flexor tendon has retracted. Jersey finger is a surgical urgency because the tendon retracts further with time.
How We Make the Diagnosis
exam first, imaging when it changes the planHand X-rays identify most fractures. Rotational alignment is something the doctor checks on exam, not on an X-ray. A CT scan is occasionally needed for complex fractures into a joint, where the 3D anatomy matters for surgical planning.
How We Treat It
what we try first, in orderMost hand fractures heal without surgery, and the goal is the same throughout: a finger that moves straight and bends fully once the bone is solid. The treatments below are grouped by what the fracture pattern allows.
Buddy Taping and Splinting
Most hand fractures heal without surgery. Stable metacarpal neck fractures are treated with buddy taping or a short ulnar gutter splint, with early motion starting within a week or two. The neighboring metacarpals act as an internal splint, which is why so many of these breaks settle down without an operation.
Stack Splint for Mallet Finger
Mallet finger is treated with a stack splint holding the fingertip joint (the DIP joint) in extension for six to eight weeks straight. The fingertip is kept straight without interruption so the extensor tendon can reattach.
When Surgery Is Considered
Surgery is offered when the fracture pattern will not produce a finger that moves straight and bends fully:
- Metacarpal fracture with rotational deformity: any rotation that causes finger crossover needs correction. More on metacarpal fixation →
- Phalangeal fracture, displaced or intra-articular, pins or screws to restore alignment. More on phalanx fixation →
- Mallet finger with a large bony fragment, pinning when the fragment involves more than a third of the joint surface and the joint is subluxated.
- Jersey finger, surgical repair within 7 to 10 days.
If non-operative care is not enough, these procedures are offered here:
Frequently Asked
questions we hear in clinicDo most hand fractures need surgery?
No. Most hand fractures heal without surgery. Stable metacarpal neck fractures are treated with buddy taping or a short splint, and the neighboring metacarpals act as an internal splint. The fractures that need an operation are the ones with significant shortening, rotational deformity, a joint surface that is no longer smooth, or involvement of the metacarpal base joint.
What is a boxer's fracture?
It is a fracture of the fifth metacarpal neck, the bone behind the little-finger knuckle. It is the hand fracture seen most often, usually from punching something harder than the hand. Most heal with buddy taping or a short splint.
Why does the doctor watch me make a fist?
To check rotational alignment, which is a clinical exam finding rather than something an X-ray shows. Making a fist slowly lets us watch whether all the fingers converge toward the same point at the wrist. If one finger crosses over its neighbor, there is a rotational deformity that needs correction.
What is the difference between mallet finger and jersey finger?
They are opposites. In mallet finger the extensor tendon pulls off the distal phalanx, so the fingertip droops and you cannot straighten it actively, though it still straightens passively. In jersey finger the flexor tendon avulses, so you cannot bend the tip, with tenderness along the palm side of the finger where the tendon has retracted.
How is mallet finger treated?
With a stack splint that holds the fingertip joint straight for six to eight weeks without interruption. Surgery is reserved for a mallet finger with a large bony fragment, when the fragment involves more than a third of the joint surface and the joint is subluxated.
Why is jersey finger treated as urgent?
Because the flexor tendon retracts further with time. Jersey finger is repaired surgically within 7 to 10 days, so it is one of the few hand injuries treated as a surgical urgency.
Will I need a CT scan?
Usually not. Hand X-rays identify most fractures. A CT is occasionally needed for complex fractures into a joint, where the 3D anatomy matters for surgical planning.
Providers Who Treat Hand Fractures
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: