Metacarpal Fractures

Metacarpal fractures are prevalent hand injuries, constituting 18–47% of all hand fractures, with the fifth ray being most commonly affected. While crush and direct blow mechanisms, especially in the context of activities like punching, contribute to metacarpal fractures, higher-energy incidents like motor vehicle accidents can lead to multiple fractures and associated instabilities. Diagnosis involves recognizing pain, swelling, ecchymosis, and deformity during examination. Non-thumb metacarpal fractures often undergo successful nonoperative management, considering factors like location, articular involvement, and rotation. Surgical options, including K-wire fixation, intramedullary screws, and plates with screws, become necessary for open fractures, multiple fractures, rotational malalignment, and significant angulation. Careful postoperative rehabilitation is crucial, tailored to the chosen fixation, with a return to play decision contingent on individual factors and collaboration between the treating surgeon and the athlete.