The metacarpals are the bones that make up the hand itself. Most metacarpal fractures can be treated without surgery. The most common metacarpal fracture is the ‘Boxer’s Fracture’, which is a fracture of the 5th (small finger) metacarpal close to the knuckle, usually from punching a hard object. The vast majority of Boxer’s Fractures can be treated in a splint, without surgery. (See http://www.rearmyourselftexas.com/hand/finger-fractures/ for more information)
There are some metacarpal fractures that should be surgically repaired. Metacarpal fractures that have rotated lead to ‘scissoring’. Scissoring occurs when the fractured finger overlaps other fingers, or goes outside the palm of the hand, when making a fist. (See http://www.rearmyourselftexas.com/hand/finger-fractures/ for a diagram of scissoring). Metacarpal fractures that have significant angulation (bending) or displacement (translation) should be fixed to allow optimum hand function. Fractures of two or more metacarpals in the same hand should usually be fixed because these injuries are often unstable and, if allowed to heal without surgery, shortening and displacement of the fractured bones often occurs.
While some metacarpal fractures can be pinned, my preference is to rigidly fix most metacarpal fractures with a plate and screws. (A video of this can be seen at http://www.rearmyourselftexas.com/hand/finger-fractures/). Surgical fixation of metacarpal fractures is performed on an outpatient basis. In order to maximize hand motion and function, hand therapy is usually started 2-3 days after surgery. When combined with good hand therapy and a motivated patient, surgical fixation of metacarpal fractures is highly effective at returning the hand to excellent function.