Fifth Metacarpal Base Fractures: Diagnosis and Treatment - Orthopedics

More Info

---

Fifth metacarpal base fractures, commonly known as "boxer's fractures," are a type of injury that occurs at the base of the fifth metacarpal bone, which is the bone that connects the wrist to the little finger. These fractures typically result from a direct impact, such as punching an object, but can also occur from falls or accidents, like the car accident you experienced.


Diagnosis
The diagnosis of a fifth metacarpal base fracture usually involves a combination of clinical evaluation and imaging studies. In your case, it seems that an X-ray was performed initially, but the fracture was not identified at that time. This can happen if the fracture is non-displaced or if the X-ray was not adequately assessed. After a month of persistent pain, a follow-up visit to another hospital led to the correct diagnosis. It’s essential to have a thorough examination and possibly additional imaging, such as a CT scan, if the fracture is suspected but not clearly visible on X-rays.


Treatment
The standard treatment for a fifth metacarpal base fracture often involves immobilization with a cast or splint for a period of 4 to 6 weeks, as you experienced. This allows the bone to heal properly. After the immobilization period, physical therapy may be recommended to restore strength and range of motion to the hand and wrist.


Current Symptoms
Regarding your current symptoms of inner forearm pain and wrist discomfort, there are several potential explanations:
1. Delayed Healing or Nonunion: If the fracture did not heal properly, it could lead to ongoing pain. This is more common in fractures that are not adequately immobilized or if there is significant movement during the healing process.

2. Referred Pain: Sometimes, pain in the wrist or forearm can be referred from the site of the fracture. The surrounding muscles and tendons may also be strained due to compensatory movements while the fracture was healing.

3. Tendonitis or Strain: The pain you are experiencing could be due to tendonitis or strain in the muscles and tendons around the wrist and forearm, especially if you have been using your hand more than usual during the healing process.

4. Nerve Compression: In some cases, swelling or changes in the anatomy due to the fracture can lead to nerve compression, which may cause pain or discomfort in the wrist and forearm.


Recommendations
1. Follow-Up Consultation: It is crucial to follow up with your orthopedic doctor or a hand specialist. They may recommend additional imaging studies to assess the healing of the fracture and rule out any complications.

2. Physical Therapy: If you haven’t started physical therapy yet, it may be beneficial. A therapist can help you with exercises to improve strength and flexibility, which can alleviate pain and prevent stiffness.

3. Pain Management: Over-the-counter pain relievers, such as ibuprofen or acetaminophen, can help manage pain. However, consult your doctor before taking any medication, especially if you have other health conditions or are taking other medications.

4. Activity Modification: Avoid activities that exacerbate the pain. Gradually reintroducing movement and strength training under the guidance of a healthcare professional can help.

In conclusion, while the initial treatment for your fifth metacarpal base fracture seems appropriate, your ongoing symptoms warrant further evaluation. It’s essential to address these issues promptly to ensure proper healing and regain full function of your hand and wrist.