Metacarpal fractures in the athlete

Abstract

Fifty-six fractures of the metacarpal occurring in 53 athletes were studied from September 1985 to Decem ber 1986, regarding mechanism of injury, type of frac ture, type of treatment, and time lost from sport. Age range of the patients was 8 to 28 years with greater than 77% being in the 14 to 18 year age range, the high school athlete. Twenty-nine of the fractures oc curred in football, 14 in basketball, and the remainder were divided between various other sports. The most common mechanism of injury involved falls or hitting an object such as a helmet or another player. Fractures were evenly divided regarding which digit was involved in football, whereas most basketball injuries occurred in the fourth and fifth metacarpal. Fractures were ana lyzed as to type of radiographic appearance and this was correlated with time lost from competition or par ticipation. No significant difference among fracture type regarding time lost was noted. Forty-six of the fractures (82%) were minimally dis placed or undisplaced and were treated by means of simple casting and/or splinting whereas 10 were dis placed. Two of the 10 underwent closed reduction and casting; 3 underwent closed reduction and percuta neous pin fixation; and 5 (9%) underwent open reduc tion internal fixation using AO type plates and screws. All fractures healed primarily clinically and radiographi cally. The average time lost from practice or competition in this group overall was 13.7 days, (range, 0 to 56 days). Average time lost from basketball was 19.8 days and from football 10.63 days overall. Average time lost from sport in stable fractures treated with casting or splinting was 12.3 days. Those undergoing open reduction in ternal fixation with plate and screws averaged 13.6 days. We concluded that most metacarpal fractures in the athlete can be treated by closed means with a fairly rapid return to sport, depending on type of sport and position played. In certain displaced fractures, open reduction internal fixation can expedite early return to function and return to sport.