A metacarpal fracture is a fracture (break) of the tubular bones within the palm (metacarpals). They classically occur in the small finger metacarpal bone in boxers or athletes of other pugilistic sports or activities. This type of fracture has therefore become to be known as a “boxer’s fracture.” Each of the digits of the hand has a corresponding metacarpal bone associated with it, and any of these metacarpals may be fractured during a high energy impact to an athlete’s hand. These injuries are also common in other sports besides boxing. For example Ronnie Brown of the Miami Dolphins and Tony Romo of the Dallas Cowboys each spent time on the IR from suffering a metacarpal fracture as did the Mavericks Jason Terry who had surgery to fix his metacarpal fracture. The metacarpals are the tubular bones that comprise most of the space in the palm. Each of the fingers (digits) has a corresponding metacarpal that links the wrist bones to the phalanges (individual bones of the fingers). There are flexor tendons on the palm side of the metacarpals that act to flex, or bend the fingers as in making a fist. There are extensor tendons on the back of the hand that act to extend, or straighten the fingers. In between the metacarpal bones are the small intrinsic muscles (the interosseous and lumbrical muscles) that further help to control fine finger motion. When a metacarpal fracture happens, the finger flexors and the intrinsic muscles act together to bend the fracture toward the palm (apex dorsal angulation). How much the fracture bends is somewhat dependant on how much force caused the injury in the first place. A higher force injury can lead to more bending (displacement of the fracture). In an athlete’s normal uninjured hand, there is less motion at the joints of the index and long finger and more motion at the ring and small fingers. The increased motion at the two smaller fingers allows for more angulation to be acceptable as the fracture heals. This is because the increased normal motion of these two metacarpal bones can allow the hand to adapt to any permanent deformity. On the other hand, the index and long fingers’ have lesser ability to adapt to metacarpal fracture bending because they have less natural motion. The normal motion of the metacarpals can be seen when one makes a tight fist while watching the ring and small finger side of the back of the hand bend further inward. An injured athlete will describe a forceful blow to the hand. It will often be due to a punching injury or a direct blow from a fall or crush injury. Their hand will be very painful, maximally so over the specific metacarpal bone that is fractured. There will be swelling, often a considerable amount, as well as bruising directly over the injury. They may have difficulty moving the fingers due to the amount of... |
What is the anatomy of the scaphoid? The scaphoid is a small bone in the wrist on the thumb side. The wrist is a complex joint which is composed of the end of the radius (the big bone in the forearm, on the thumb side), the ulna (the small bone in the forearm, on the small finger side) as well as the carpal bones. There are 8 carpal bones: the scaphoid, lunate, triquetrum, pisiform, hamate, capitate, trapezoid, and trapezium. These bones are connected by ligaments, making the wrist a fairly complex joint. The scaphoid is the most commonly fractured wrist (“carpal”) bone. It is located in the thumb side of the wrist. If you put your thumb up in the air (like a hitchhiker) you will make a small depression at the base of your thumb. This depression is called the “anatomic snuffbox.” If you press with your finger deep into the floor of the anatomic snuffbox, you can barely feel the scaphoid. The scaphoid plays a critical role in maintaining the normal, pain-free motion of the wrist that is required with many athletic activities. The scaphoid doesn’t have a great blood supply, which is one of the reasons that the scaphoid fracture sometimes don’t heal. Its blood supply comes mostly from the far (distal) end instead of the near (proximal) end. The scaphoid is shaped like a twisted peanut and is only about 1 inch long or a little shorter. Eighty percent of the scaphoid is covered with cartilage, such that most fractures of the scaphoid bone will extend into some joint. A scaphoid fracture is a common, career-threatening wrist injury that has been seen in virtually every sport. A scaphoid fracture is any break or crack in the scaphoid. There are many different ways one can experience a scaphoid fracture, and the type of fracture may change how it is treated. Usually it results from either direct trauma to the wrist in contact athletes, or indirectly from a fall on an outstretched hand and wrist with other sports. There are several ways to describe a scaphoid fracture. They may be displaced or nondisplaced. If the fracture is nondisplaced, it is still perfectly lined up. These may be considered for treatment without surgery (with a cast). Most displaced fractures benefit from surgery. Surgery can allow better “reduction” or alignment of the fracture fragments into a normal position, and can increase the rate of predictable healing of the fracture. A scaphoid fracture can also be described by the location. It may be at the far end (distal pole), in the middle (waist), or at the near end (proximal pole). The fractures at the near end (closer to the elbow, proximal pole) have a poorer blood supply and are less likely to heal without surgery. In addition, the “near end” (proximal pole) is at risk for dying (“avascular necrosis”) without prompt treatment. Several other terms may be used to describe a scaphoid fracture. An acute fracture is one that is diagnosed soon after it happene... |