Let’s go over what a metacarpal base fracture is — and what to expect during recovery.

 

Metacarpals are the long bones of the hand which connect the wrist joint to each of the fingers. Each finger has its own metacarpal. The proximal end of the bone, closest to the wrist, is known as the base of the metacarpal. Here, it articulates with the smaller carpal bones to form the CMC joint of the wrist. A fracture affecting the metacarpal base means the break is close to one of these joints.

 

These injuries usually happen after a fall or direct blow to the hand — for example, punching a hard object, or catching the hand awkwardly during sport. Occasionally, the fracture can extend into the joint itself. In some cases, a break extending into the joint may lead to unstable or misaligned joint surfaces. As a smooth and well-positioned joint surface is what allows you to move each joint without pain or stiffness, these fractures of the CMC joint need more careful management.

 

Alongside your individual lifestyle factors and medical background, the treatment plan depends on which metacarpal is involved, whether the joint is affected, and how far out of position the bones are. Fractures that appear relatively stable and well-aligned can be treated without surgery. These are typically managed in a splint or a plaster cast which helps to stabilise the bone fragments and rest the hand to allow early healing.

 

We usually see patients in the fracture clinic one or two weeks after their injury to assess the hand, review their X-rays, and check whether the fracture remains in a safe position. If there is any concern that the joint is unstable — or that the bones are not in an appropriate position — further imaging or a hand specialist opinion may be arranged to get a more detailed look. In some cases, an operation may be recommended to re-align and stabilise the joint.

 

For patients managed without surgery, the usual plan is around three to four weeks immobilised in a splint or cast. During this period, it’s important to keep the hand elevated and to regularly move the unaffected fingers to prevent stiffness. Once the initial immobilisation period is over, patients will be referred to the hand therapy team, where they can begin gradually increasing hand use for light activities.

 

Stiffness or ongoing swelling is common after the cast or splint is removed, and you may experience some discomfort in when gripping or pinching. This usually improves steadily with time, healing and progressive exercise. Your engagement in hand therapy activities is one of the most important factors to improve your outcomes, and it is important to perform their recommended exercises regularly, in a self-directed manner.

 

Most people are able to return to light activities by five to six weeks. High-impact activity or heavy lifting should be avoided until around eight weeks, ensuring the hand feels strong and comfortable as heavier use is gradually introduced. It’s not unusual for the hand to feel slightly swollen or achy for a few months, especially after hand-heavy activities.

 

If you experience ongoing pain, poor of grip strength or reduced movement beyond the expected recovery window, you can arrange a further review in the fracture clinic.