How I Manage Fractured Metacarpals in Athletes

In brief: The six most common types of metacarpal fractures are (1) intra-articular fractures of the metacarpophalangeal joint; (2) compacted fractures through the metacarpal neck-the so-called boxer's or punch fracture; (3) transverse or short oblique fractures of the shaft; (4) spiral fractures of the shaft; (5) proximal fractures and fracture-dislocations of the fifth metacarpal; and (6) thumb metacarpal fractures. Conservative treatment is preferable for most injuries of the hand, but surgical repair is indicated in a few patients. Some sports regulate whether a cast can be worn during competition, but many athletes with these fractures can return to early participation with a splinting device that offers optimal protection to both the injured player and the Opponent.