Recovery After Fourth Metacarpal Fracture Surgery

Q: Recovery After Fourth Metacarpal Fracture Surgery

Hello Lin： After a fracture of the metacarpal bone and subsequent surgery with the insertion of a steel pin, it is possible that improper rehabilitation during the immobilization period may lead to stiffness and weakness in the muscles and joints. <br>Typically, with active rehab

May I ask the doctor?

Dear Doctor: I fractured my fourth metacarpal on May 1, and underwent surgery to insert a pin on May 3.
After the surgery, the pin was removed on May 31.
However, my hand muscles have become stiff, and I experience soreness during movement.
Additionally, there is a phenomenon where the joint of the fractured fourth metacarpal appears weak and shifts towards the palm.
Could this indicate a re-fracture of the bone, or is it a normal occurrence? If it is normal, how should I proceed with rehabilitation? After rehabilitation, will I be able to regain the same level of smooth movement I had before the fracture? I apologize for having many questions, but I am very concerned about the possibility of permanent disability.
Thank you for your guidance.

Lin, 20~29 year old female. Ask Date: 2006/06/10

Dr. Chu Baijun reply Orthopedics

Hello Lin: After a fracture of the metacarpal bone and subsequent surgery with the insertion of a steel pin, it is possible that improper rehabilitation during the immobilization period may lead to stiffness and weakness in the muscles and joints.
Typically, with active rehabilitation, symptoms can significantly improve, and most patients can return to normal function.
As for the "weakness and palmar displacement of the fractured fourth metacarpal joint" that you described, it is difficult to fully understand the condition you are referring to.
If the angle and rotation of the bone were properly considered during the surgical fixation, there should not be significant issues after the bone heals.
Sincerely, Dr.
Chou, Orthopedic Surgeon.

Reply Date: 2006/06/10

More Info

Recovering from a fourth metacarpal fracture can be a challenging process, especially after surgical intervention. It’s understandable to have concerns about the healing process, potential complications, and the future functionality of your hand. Let’s break down your situation and address your concerns.

Firstly, it’s important to recognize that after a fracture and subsequent surgery, it is common to experience stiffness and discomfort in the affected area. The surgical procedure you underwent, which involved the insertion of a pin to stabilize the fracture, is designed to allow the bone to heal properly. However, immobilization during the healing process can lead to muscle atrophy and joint stiffness, which may explain the rigidity and soreness you are currently experiencing.

Regarding your concern about the joint appearing weak and shifting towards the palm, this could be a result of several factors. It’s possible that the soft tissue surrounding the joint has not fully regained its strength and flexibility, leading to a feeling of instability. However, it is also crucial to rule out any complications such as malunion (where the bone heals improperly) or nonunion (where the bone fails to heal). If you are experiencing significant pain or if the joint appears to be misaligned, it is advisable to consult your orthopedic surgeon for an evaluation. They may recommend imaging studies, such as X-rays, to assess the healing status of the bone and ensure that there are no new fractures or complications.

As for rehabilitation, it is essential to start a structured physical therapy program to regain strength and mobility in your hand. Here are some general guidelines for rehabilitation after a fourth metacarpal fracture:
1. Gentle Range of Motion Exercises: Start with passive and active range of motion exercises to improve flexibility in your fingers and wrist. This can include finger flexion and extension, as well as wrist movements. It’s crucial to perform these exercises gently to avoid exacerbating any pain.

2. Strengthening Exercises: Once you have regained some range of motion, you can begin strengthening exercises. This may involve using putty or small weights to improve grip strength and overall hand function. Your physical therapist can guide you on the appropriate timing and type of exercises based on your healing progress.

3. Gradual Increase in Activity: As your strength and mobility improve, gradually increase the intensity and complexity of your exercises. This can include functional tasks that mimic daily activities, such as gripping objects or performing fine motor tasks.

4. Pain Management: If you experience pain during rehabilitation, it’s important to manage it appropriately. This can include using ice, over-the-counter pain medications, or other modalities as recommended by your healthcare provider.

5. Consistency and Patience: Recovery takes time, and consistency is key. Regular therapy sessions and adherence to your home exercise program will be crucial for optimal recovery.

Regarding your concern about returning to pre-injury function, many individuals can regain full or near-full function after a metacarpal fracture with appropriate rehabilitation. However, the extent of recovery can vary based on factors such as the severity of the fracture, the quality of the surgical repair, and your commitment to rehabilitation.

In summary, while it is normal to experience stiffness and discomfort after surgery, it is essential to monitor your symptoms closely and communicate with your healthcare provider about any concerns. Engaging in a structured rehabilitation program will be vital for regaining strength and function in your hand. With time and effort, many patients can return to their previous level of activity and functionality. If you have any further questions or concerns, do not hesitate to reach out to your healthcare team for guidance.

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