It depends upon what type of 5th metacarpal fracture it is. After 8 weeks the bone is probably healed. If the fracture is not affecting the function of the hand, no hand surgeon will operate on it. However, if it is causing significant problems with your occupation, then something might be done. However, the surgeon would most likely, at this time, have you do some therapy to see how much function you regain. Also, they usually want the injury to be healed as much as possible, and as much function regained as possible, before considering a reconstructive effort. It's best to do a reconstructive effort in a hand that is physiologically quiet, with no inflammation or swelling. This reduces the risk of severe adhesions of the tendons.
Usually, in 5th metacarpal fractures, reconstructions are done for; rotational deformities, which cause the fingers to overlap or scissor; for midshaft fractures that cause significant clawing of the small finger, precluding strong grasp or full extension; for fractures at the base of the 5th metacarpal (a reverse Bennett's fracture), which has developed significant arthritic changes. Boxer's fractures can be angulated as much as 70 degrees without causing any functional problem. The loss of knuckle height is not a reason to do surgery. In acute Boxer's fractures, reduction is aimed at getting the angulation corrected as much as possible, but angulation of 40 degrees is acceptable. The vast majority of Boxer's fractures are treated nonoperatively. Only if it is intraarticular, or angulated and unstable to a great degree, are they surgically treated.
But, by all means, get a second opinion if you desire. You might want to see a specialist is hand surgery though.
Hello everybody and especially Gaelic, I've read some of your posts here when googling info about orthoproblems and you are very helpful and know a lot
First, sorry for my English, it is not my first language, second, sorry for not making another thread but I think it will people searching for info help in the future when information about the same problem (5th metacarpal fracture) is in one thread.
I broke my fifth metacarpal 10 weeks ago, the doc put my hand in the splint for 6 weeks (the bone callus was not like it should be, healing process was slower, that was the reason, normally they put it in the cast for 5 weeks). Fortunately no surgery was needed.
Week and something after the splint was removed I went to phisyotherapy to help my pinky finger to get full range of movement again. The pinky was stiff in the metacarpal joint, very stiff. Before I visited PT for the first time I consulted this with a doc and he told me its probably adhesed extensor to the surrounding tissues and it is common, usually exercises are enough to get it back to normal, but I have to "work hard".
Ok, I've been working hard, not only with my physio, but at home too. Now I can bend my pinky around 60 degrees down, when put another hand under the metacarpal knuckle on my palm I can bend it almost 80 degrees. When doing exercises for around five minutes (or in warm water) I can bend it more, maybe 100 degrees, which is almost same like on another hand (120 degrees). The problem is I cant touch my palm and straighten my finger in this position like I can on my another hand (where I can almost straighten the pinky). And it hurts a bit between my knuckle joint and PIP (the tendon?). I can reach such range of motion only after few minutes of exercising. In the morning the finger is stiff much more, I can bend it only around 40%.
Because its my dominant hand, I worry little and I would like to ask:
1. Would be possible to bend the pinky so much, even in the warm water and after "warm uping" it, if the extensor was still adhesed at some places?
2. Will my current maximum ROM become standard in the morning and during the day without exercises? And when? I've been doing physio-training for 3 weeks now (and its 4 weeks after the splint was removed).
3. Can my ROM be limited due to the fracture and thats the reason why I cant bend it more than 100 degrees?
You do not say what position your MCPJ was immobilized in. Because of the shape of the bones, the MCPJ should be immobilized in full flexion (or as much as possible and still keep the fracture reduced). On the same line, the PIPJ should be immobilized in full extension. This is called the "safe position" or "James position".
But, that is a moot point now.
It is always possible that the way the fractue healed has reduced your ROM. But, it is more likely that you are still rehbilitating from the injury and immobilization.
You do not say where your metacarpal fracture was located.
While it is very common for Boxer's Fractures (fracture through the metacarpal neck) to heal with some angulation of the fracture, it is rarely a problem.
However, with metacarpal shaft fractures, it is not uncommon for the extensor tendons to scar down some, which can limit flexion. Also, if a shaft fracture heals with too much angulation, it can affect ROM and also strength of grasp.
But, since you get more motion after warming the tissue and doing therapy, and also that you have stiffness after a period of rest (upon rising in the morning), both of these are signs of inflammation, it is much more likely that you will regain more motion as time goes by and you fully recover from the fracture.
At 10 weeks, you are still in the active rehabilitation stage.
Keep working on your motion and strength. It should get better with time and therapy.
Thank you for your fast reply and very informative post, Gaelic.
My fracture was a typical boxers fracture, I punched a wooden desk (it was more accident and bad luck than intended punch) and broke the neck of the fifth metacarpal.
The pinky had been immobilized in the position you described.
I compared my broken pinky's ROM with the one on another hand and was worried. But today I asked two people to show me if they are able to move their pinky like I do on my good hand and they can not. So maybe its some kind of abnormality on my good hand (ROM is really huge, 120 degrees and I can touch almost my wrist with minimal bend in PIP) and my healing pinky is very near to "general perfection" when doing exercises.
Thank you very much for giving me hope and supporting me
As you have found out, the amount of ROM that a particular patient has is quite variable. Most hand surgeons usually use the patient's ability to function and do his/her necessary activities, rather than an absolute numbner of degrees of ROM, in determining whether a treatment was successful or not.
Range of motion can also differ between hands in the same patient. Dominance of the hands often plays a part in range of motion and strength between the two hands.
So, as long as you can do the activities that you need to do, the absolute amount of ROM is not as important. And, again, you are only 10 weeks out from injury, and about a month out from getting out of the cast, so you are still in the active rehab period. It is not uncommon for patients to continue to improve after immobilization of a fracture for several months. Thus, you will probably continue to increase your ROM for some time yet and, of course, your strength will increase as you use the hand more and more.
One note on Boxer’s fractures: it is common for these fractures to heal with some angulation at the fracture site. The surgeon will attempt to reduce the fracture as best as possible and hold that reduction with immobilization. The angulation which is considered to be adequate is anything less than 30 degrees. However, there are some studies which have shown that angulation greater than 30 degrees still do not affect overall function of the hand, other than the prominence of the metacarpal head in the palm of the hand. The loss of the “knuckle” (the MCPJ) is a cosmetic problem. However, the best reduction is the one with the least amount of residual angulation.
Keep working on your therapy, both ROM and strengthening. It will probably be several more months before you have reached your full recovery. Good luck.