By Dev K. Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- Most hand metacarpal fractures in high school aged athletes can be treated in a cast, although in some instances surgery may be needed
- Cast treatment will typically allow unrestricted return to play in about 4 weeks for noncontact sports and about 6 weeks for contact sports
- Sports requiring finger dexterity and power may take longer than 6 weeks for return
The metacarpal bones are the long bones in the hand that lead up to the fingers. They’re injured typically from direct contact such as a fall to the ground, hitting something with a clenched fist, or a hand hit by a pitch.
A team physician or athletic trainer on the field of play can often have a very good idea of a possible hand metacarpal fracture when we examine the athlete on the sideline immediately after the injury, before swelling sets in. With fractures, the athlete will often have considerable pain. Swelling and bruising can appear within a few minutes.
The diagnosis is confirmed with X-rays. Most of these fractures can be treated without surgery, although in some instances with high school, college, and professional athletes surgery will be done to allow a faster return to play. If the fracture is out of position (“displaced”) or angulated, surgery might be needed to restore alignment and hold the break in the correct position for healing. Other fractures will typically be treated without surgery using a cast or brace. For professional athletes where time to return to play is especially critical, we may also use a bone growth stimulator.
For breaks being treated in a cast, you should expect the cast to be on for about 3-4 weeks. Follow-up x-rays will determine the healing, and when the cast can be removed.
If surgery is needed, the hand specialist will determine the best type of fixation based upon the type of fracture and the surgeon’s preference. The goal is to stabilize and properly align the fracture and to permit early movement of the wrist and fingers.
The time for return to sports depends on the sport and how quickly the bones heal. If it is a sport where the athlete could play in a padded cast or brace, the athlete might be able to return quickly.
- Cast treatment for high school aged athlete in a non-contact sport, usually about 4 weeks to unrestricted return
- Cast treatment for a high school aged athlete in a contact sport, usually about 6 weeks for unrestricted play
- Cast treatment for sports allowing return with a padded cast or brace, could be as early as 1-2 weeks in the padded cast
- Surgery might allow return in 1-2 weeks with a padded cast or brace but this is a complicated decision and will require careful discussion with your surgeon about the risks and benefits of early return after surgery
- Sports requiring dexterity of the fingers (for example the throwing hand of a pitcher) may take longer than 6 weeks as motion and strength will also need to return.