Overview
Metacarpals are the long bones of the hand between the wrist and the fingers. Many metacarpal fractures — especially boxer's fractures of the fifth metacarpal neck — heal well with a short period of immobilization. Surgery is considered when alignment cannot be held, when the fracture rotates the finger, or when multiple bones are involved.
The most important clinical finding is rotational alignment: when the fingers are flexed, they should all point toward the scaphoid. Any rotational malalignment is a strong indication for surgical correction regardless of the X-ray angle.
Why it's done
Metacarpal ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Rotational malalignment
Crossover or scissoring of the finger during flexion.
Significant angulation or shortening
Beyond accepted limits for the specific metacarpal.
Open fracture
Urgent surgical irrigation and stabilization.
Intra-articular fracture
Step-off at a knuckle joint requires reduction.
Multiple metacarpal fractures
Loss of the hand's stable arch justifies operative fixation.
How it works
Options include percutaneous pinning with smooth K-wires, intramedullary screw or nail techniques, and formal open plate-and-screw fixation. The choice depends on fracture location, comminution, and surgeon preference.
For shaft fractures, a small dorsal incision exposes the bone; a low-profile plate is applied and secured with screws. Pin fixation is often performed percutaneously under fluoroscopy with a small stab incision.
Recovery
The hand is protected in a splint early on, with finger motion started right away to prevent stiffness. Hand therapy is important. Pin removal, when pins are used, happens in the clinic once the bone is healing reliably. Full strength returns gradually. Stiffness and tendon adhesion are the most common complications.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a malaligned hand that loses grip, catches when making a fist, and develops a visible deformity. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before metacarpal orif include:
- bleeding and infection
- anesthesia risk
- stiffness of the MCP and PIP joints
- tendon adhesions around plate hardware
- hardware irritation
- loss of reduction
- scar tenderness
The indication to proceed is a displaced, rotated, or unstable metacarpal fracture that cannot be held closed. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: