Finger and Metacarpal Fractures in Vienna
A fall onto the hand, a ball striking an outstretched finger, a blow against something hard: the hand swells, hurts and cannot be closed into a fist. I examine the hand, assess the alignment and stability of the fracture and discuss the next steps with you.
In short
A finger or metacarpal fracture is usually caused by a fall, an impact or a blow; typical signs are swelling, pinpoint tenderness and difficulty making a full fist. What matters is the position of the fragments: a rotational deformity makes the finger cross over its neighbour when you make a fist and has to be corrected. I treat stable fractures with a splint or buddy taping and early, guided movement, and displaced fractures or fractures close to a joint with a screw, plate or wire. I treat injured flexor and extensor tendons promptly.
What is a finger or metacarpal fracture?
Each finger consists of three small tubular bones — the proximal, middle and distal phalanx — and the thumb of two. Behind them lie the five metacarpal bones (ossa metacarpalia), which form the back of the hand and set the axis of the fingers. If one of them breaks, the geometry of a finely balanced system of joints, tendons and ligaments changes.
The causes are usually everyday ones: a fall onto the outstretched hand, a trapped finger or a blow against something hard. A fracture of the fifth metacarpal just below the knuckle of the little finger is called a boxer's fracture. I often see finger fractures in ball and contact sports; more on this under sports orthopaedics in Vienna.
Not every injury is a fracture. If the extensor tendon tears away at the distal phalanx, the fingertip droops limply. Flexor tendons are severed by cuts or tear away from the bone when gripping forcefully; the joint then no longer bends actively. Because bone and tendon injuries can occur together, I always check both.
Typical symptoms
- Swelling and bruising — the finger or the back of the hand swells quickly.
- Tenderness — pinpoint over the fracture site, increasing with load.
- Visible deformity — a kink, shortening or a sunken knuckle.
- Rotational deformity — the finger crosses over its neighbour when you make a fist.
- Incomplete fist — the hand no longer closes fully.
- Loss of tendon function — the fingertip droops or the joint no longer bends.
- Numbness or tingling — a sign of injured finger nerves, usually after cuts.
How I make the diagnosis
It starts with a detailed conversation about how the accident happened, your work and your sporting demands. I then examine the hand clinically: I palpate the fracture site, check alignment and rotation as you make a fist, test each flexor and extensor tendon individually and check circulation and sensation. Ultrasound is available to me in the practice; with it I assess tendons and soft tissues in motion. For the bone I arrange an X-ray and, if a joint is involved, additionally a CT scan or an MRI.
Treatment: conservative first
Many finger and metacarpal fractures do not need an operation. If the fracture is stable, without rotational deformity and without significant displacement, immobilisation is sufficient: a fitted splint that holds the joints in a position in which the ligaments do not shorten, or buddy taping, which guides the injured finger alongside its healthy neighbour.
In the hand, immobilisation is a compromise: the bone needs rest, the joints need movement. That is why I keep it as short as is justifiable and have you move all unaffected joints from the start. Elevation is part of this, as are physiotherapy and exercise therapy at the Orthozentrum Döbling and, in addition, magnetic field therapy. Follow-up X-rays show whether the fracture stays in position.
A tear of the extensor tendon at the distal phalanx can also often be treated without an operation, provided the end joint of the finger is kept straight in a splint continuously; this takes patience, because any interruption sets the healing back.
When an operation is necessary
Clear findings speak in favour of a procedure: a rotational deformity, marked angulation, a fracture extending into the joint, an open fracture or a fracture that slips at a follow-up check. The aim is stability that allows early movement: in the hand, mobility matters as much as bony healing.
Depending on the fracture pattern, I use small screws, a narrow plate or wires; the incision is kept as small as possible so that the gliding layers of the tendons are spared. With tendon injuries, timing matters: I repair a severed flexor tendon promptly, because otherwise the tendon ends retract and form adhesions.
I carry out necessary procedures at the ATOMOS Klinik Währing, the Privatklinik Döbling or the Rudolfinerhaus, and I accompany you from planning through the procedure to aftercare.
My practice is a private practice, in Austria a Wahlarztordination. I do not settle directly with any public health insurer; you receive an invoice and submit it to your insurer — on request I take care of the submission for you. More on this under how a private practice works.
If the injury extends further up towards the wrist, a distal radius fracture or a scaphoid fracture may be involved. If the symptoms remain unclear, the overview of hand pain and its causes can help; you will find all procedures on the hand and wrist in the section on hand surgery in Vienna.
Whether an operation makes sense depends on the findings. I show you the images, explain the options and their limits, and make the decision together with you.
Frequently asked
Frequently asked questions about finger and metacarpal fractures
Only an X-ray can reliably distinguish a fracture from a bruise. Warning signs are rapid swelling, pinpoint tenderness over the bone, a visible deformity and a finger that crosses over its neighbour when you make a fist. A finger that can still be moved may also be broken. If you notice these signs, have your hand examined promptly.
This is the name for a fracture of the fifth metacarpal just below the knuckle of the little finger. It happens when a clenched fist strikes something hard. Typical signs are swelling on the back of the hand and a sunken knuckle. Whether surgery is needed depends on how far the fragment has tilted and on whether the little finger is rotated when you make a fist.
Because it is magnified towards the fingertip. A slight twist at the fracture site means that, when you make a fist, the finger no longer points into the palm but runs over the neighbouring finger. This permanently impairs gripping and fine motor skills and can only be corrected later with greater effort.
No. If the fracture is stable, without rotational deformity and without significant displacement, I treat it with a splint or buddy taping and have you start guided movement early. Factors in favour of an operation are a rotational deformity, marked displacement, a fracture extending into the joint, open fractures or a fracture that slips at a follow-up check.
What matters is which movement you can no longer perform actively. If the fingertip droops limply and cannot be straightened actively, this suggests an injury to the extensor tendon. If a finger joint can no longer be bent actively, the flexor tendon is affected. Both should be examined promptly.
The aim of stabilisation is early, guided movement. I determine which movements are allowed from when, and coordinate the follow-up treatment with the physiotherapy and exercise therapy at the Orthozentrum Döbling. Follow-up X-rays accompany the healing process. Swelling and stiffness are part of recovery; regular exercise is just as important as the procedure itself.
Dr. med. Martin Eigenschink
Specialist in Orthopaedics and Traumatology · Specialist in elbow, shoulder and hand surgery
Surgical and conservative treatment of the elbow, shoulder and hand, preferably minimally invasive. Practice at the Orthozentrum Döbling, 1190 Vienna. More about my background
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Medical notice: The contents of this page serve as general information. They do not replace a medical examination, diagnosis or individual advice. Medicine is a constantly evolving field — despite careful research, no guarantee can be given that the content is fully up to date.