Cast for a Metacarpal Fracture: Hand Care

The design depends on which metacarpal is broken, the fracture's angle and rotation, and whether it enters a joint. A support may include the wrist and one or more fingers. Reduction or surgery may be needed when the position is unacceptable, the fracture is unstable, or there is an open wound.

Metacarpals help form the palm and position the fingers for grip. Rotation matters because a finger can cross over its neighbour when making a fist even if the hand looks fairly straight at rest.

The clinician checks knuckle shape, tendon movement, sensation, circulation, and the way the fingers line up. Follow-up may include repeat imaging because swelling decreases and some fracture patterns can shift inside a cast.

Elevate the hand above heart level during early swelling and remove rings before they become tight. Keep the cast or splint dry, protect its edges, and do not insert pens or other objects beneath it. Move every joint left free by the support as instructed, without forcing pain.

Avoid gripping, lifting, punching, or using the injured hand to push up from a chair. Do not reshape a removable splint yourself. At review, bring details of work and hobbies that require fine control or forceful grip so return-to-use advice can be specific.

Urgent assessment is needed if fingers turn blue, pale, or cold; swelling rapidly increases; numbness develops; or you cannot move a previously mobile finger. Severe worsening pain or a cast that feels progressively tighter can reflect excess pressure.

Seek prompt review for wet or broken cast material, rubbing that produces a sore, discharge, bad odour, fever, or spreading redness. If a finger begins crossing over another or the fracture appears to move, keep the hand supported and contact the fracture service.

Ask whether the fracture is rotated or involves a joint, which fingers and joints should move, and when the support can be removed. Clarify when hand therapy, scar care if relevant, strengthening, driving, computer work, and heavier manual tasks can restart.