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First (thumb) metacarpal fractures

Josh Bloom, MD, MPH
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Metacarpal fractures are among the most common hand injuries and frequently present to emergency departments and clinics. Fractures of the first metacarpal (ie, thumb metacarpal) comprise a substantial portion of these fractures.

The presentation, diagnosis, and management of first (thumb) metacarpal fractures is reviewed here. Other injuries of the thumb and surrounding tissues are discussed separately. (See "Evaluation of the patient with thumb pain" and "Scaphoid fractures" and "Ulnar collateral ligament injury (gamekeeper's or skier's thumb)" and "Overview of metacarpal fractures".)


Metacarpal fractures are common [1]. They account for 30 to 40 percent of all hand fractures. First metacarpal (thumb) fractures make up almost 25 percent of all metacarpal fractures, placing them second only to fifth metacarpal neck (ie, "boxers") fractures in terms of frequency. Of the fractures of the first metacarpal, over 80 percent involve the base.

Thumb fractures overall occur most commonly in children under age 16 and adults over age 65, but thumb metacarpal fractures occur most often among younger males (10 to 29 years old) [2,3]. They are commonly caused by falls and direct trauma secondary to sports, bicycle accidents, and from punching solid objects [4-6]. (See "Evaluation of the patient with thumb pain".)


The thumb is distinct from the other fingers anatomically and biomechanically, and of critical importance to hand function. Accordingly, fractures to the thumb are considered separately from other metacarpal fractures, and must be managed with great care (see 'Management' below). Thumb anatomy is discussed in greater detail separately, but aspects of particular relevance to thumb metacarpal fractures is discussed here (see "Finger and thumb anatomy").

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Literature review current through: Dec 2017. | This topic last updated: Dec 14, 2017.
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