Overview
Metacarpals are the long bones of the hand between the wrist and the fingers. Many metacarpal fractures, especially boxer's fractures of the fifth metacarpal neck, heal well with a short period of immobilization. Surgery is considered when alignment cannot be held, when the fracture rotates the finger, or when multiple bones are involved.
The most important clinical finding is rotational alignment: when the fingers are flexed, they should all point toward the scaphoid, a small bone at the base of the thumb. A finger that rotates out of line and crosses its neighbor when you make a fist is a strong indication for surgical correction, regardless of how the fracture angle looks on the X-ray.
Why it's done
Metacarpal ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Rotational malalignment
Crossover or scissoring of the finger during flexion.
Significant angulation or shortening
Beyond accepted limits for the specific metacarpal.
Open fracture
Urgent surgical irrigation and stabilization.
Intra-articular fracture
Step-off at a knuckle joint requires reduction.
Multiple metacarpal fractures
Loss of the hand's stable arch justifies operative fixation.
How it works
Options include pinning through the skin with smooth wires (percutaneous K-wires), a screw or nail passed down the hollow center of the bone (intramedullary fixation), and formal open plate-and-screw fixation. The choice depends on where the fracture sits, how many pieces the bone is in (comminution), and surgeon preference.
For shaft fractures, a small incision on the back of the hand exposes the bone; a low-profile plate is applied and secured with screws. Pin fixation is often done through the skin with a small stab incision, guided by fluoroscopy (live X-ray imaging in the operating room).
Recovery
The hand is protected in a splint early on, with finger motion started right away to prevent stiffness; hand therapy does much of the work in these weeks. When pins are used, they are removed in the clinic once the bone is healing reliably. Full strength returns gradually. Stiffness and tendon adhesion (scar tissue binding the tendons that glide over the plate) are the most common complications.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or schedule an appointment online.
Physicians Who Perform Metacarpal ORIF
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a misaligned hand that loses grip, catches when making a fist, and develops a visible deformity. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss with you before metacarpal ORIF include:
- bleeding and infection
- anesthesia risk
- stiffness of the knuckle and middle-finger joints (MCP and PIP joints)
- tendon adhesions around plate hardware
- hardware irritation
- loss of reduction
- scar tenderness
The indication to proceed is a displaced, rotated, or unstable metacarpal fracture that cannot be held in position without surgery. If the operation is not right for you, we will say so.
Frequently Asked
questions we hear in clinicDo all broken hand bones need surgery?
No. Many metacarpal fractures, especially boxer's fractures of the fifth metacarpal neck, heal well with a short period of immobilization. Surgery is considered when alignment cannot be held, when the fracture rotates the finger, or when multiple bones are involved.
How do I know if my finger is rotated?
When the fingers are flexed, they should all point toward the scaphoid, a small bone at the base of the thumb. A finger that rotates out of line and crosses its neighbor when you make a fist is a strong indication for surgical correction, regardless of how the fracture angle looks on the X-ray.
When can I move my fingers?
Right away. The hand is protected in a splint early on, but finger motion is started immediately to prevent stiffness, and hand therapy does much of the work in those weeks.
Does the hardware come out later?
When pins are used, they are removed in the clinic once the bone is healing reliably. Hardware irritation and tendon adhesions around plate hardware are among the risks we discuss before surgery.
What are the most common problems afterward?
Stiffness and tendon adhesion, scar tissue binding the tendons that glide over the plate, are the most common complications. Full strength returns gradually.
What happens if a bad fracture is left alone?
A displaced, rotated, or unstable fracture left untreated can leave a malaligned hand that loses grip, catches when making a fist, and develops a visible deformity. That is the trade surgery is managing.
Further Reading
External patient-education references and related OSI pages for additional background: