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What is a metacarpal fracture?

The metacarpals are the long bones of the hand. Each hand has five metacarpals, one for the thumb and one for each finger. A metacarpal fracture is a crack or break of one of these bones.

A fracture of the neck of the fifth metacarpal caused by punching a hard surface is known as a “boxer’s fracture.”

What are the different types of metacarpal fracture?

  • Hairline fracture: A crack in the bone, also known as a stress fracture
  • Non-displaced, simple fracture: A break in the bone in which the two ends remain in line
  • Displaced fracture: A broken bone in which the two ends have separated
  • Growth plate fracture: A fracture that extends into the area at the end of the bone where growth takes place
  • Interarticular fracture: A fracture that extends into the joint

Symptoms & Causes

What are some common causes of metacarpal fractures in children?

Metacarpal fractures are a type of hand fracture usually caused by a fall or direct blow that puts more force on one or more of the bones than they can withstand. The most common causes of metacarpal fractures include:

  • Sports injuries, like being hit on the hand with a lacrosse or field hockey stick
  • Falling directly onto the hand or knuckle
  • Punching a hard surface

What are the symptoms of a metacarpal fracture?

It can be hard to know if your child has a metacarpal fracture. If your child has any of these symptoms of a metacarpal fracture, seek prompt medical care:

  • A cracking or popping sound at the time of the accident
  • The hand is painful and tender to the touch
  • Your child struggles to move their fingers
  • The skin is discolored and bruised

How can I tell if my child’s hand is broken or sprained?

A sprain is when ligaments around a joint are partially torn. Sprained hands and metacarpal fractures can happen in the same way and have many of the same symptoms, making it difficult for parents to know the difference. While some sprains heal with minimal treatment, a serious sprain may require medical treatment.

If your child has any of the symptoms of a metacarpal fracture or if their hand is swollen and bruised, bring your child to a doctor who can diagnose and treat the injury.

Diagnosis & Treatments

How is a metacarpal fracture diagnosed?

At Boston Children’s Hospital, we will examine your child’s hand and use X-ray imaging to look for signs of a broken bone. An X-ray can also reveal the location and type of fracture and help us decide on the best course of treatment.

How are metacarpal fractures treated in kids?

If your child has a displaced fracture, they may need to have a reduction to put the bones in the correct position to heal.

  • A closed reduction (setting the bone without surgery) can take place in an emergency room or orthopedic exam room.
  • A surgical reduction uses plates, pins, and other hardware to stabilize a severely broken bone.

Once we know the bones are in the best position, your child will wear a cast to keep their hand immobile while the bones heal. If the metacarpal fracture is not displaced, it may be possible to stabilize your child’s hand with a splint instead of a cast.

How can I care for my child’s metacarpal fracture at home?

Soreness is usually at its worst for the first few days up to the first week after the injury. You can manage this pain with acetaminophen (Tylenol®) or ibuprofen (Advil®) as needed at home. Always talk with your provider about allergies your child may have before giving over-the-counter medication.

If your child has had surgery, we may prescribe a small amount of prescription pain medicine to manage their pain for the first few days.

Your child’s hand may swell once you get home. To help keep the swelling from drifting down and getting stuck in the fingers, prop your child’s hand up on a pillow so that it’s higher than their heart.

How long does it take to heal from a metacarpal fracture?

The time it takes to recover from a metacarpal fracture depends on the severity of the injury. Your child will probably need to avoid playground activities and contact sports for six to 12 weeks after their initial treatment.

We’ll assess how well your child’s bone is healing and recommend when your child can safely return to sports and other activities at a follow-up visit three to four weeks after your child’s initial treatment.

How we care for metacarpal fractures at Boston Children’s Hospital

The Orthopedic Urgent Clinic at Boston Children’s Hospital offers access to world-class pediatric specialists, X-ray facilities, and cast technicians in Boston, Needham, Peabody, Waltham, and Weymouth. As part of the Orthopedics and Sports Medicine Department, we provide specialized orthopedic care for children, teens, and young adults with fractures and other injuries that need prompt care.

If your child has a severe metacarpal fracture, we may refer them to our Hand and Orthopedic Upper Extremity Program. As one of the largest programs of its kind in the country, our orthopedic surgeons specialize in repairing complex hand, wrist, and upper extremity injuries in growing children, teens, and young adults. No matter what the condition, our goal is always the same: to help our patients regain function so they can reach their full potential.