There are different types of metacarpal fractures and treatment options cannot be generalized. Therefore, you should first find out what type of metacarpal fracture you belong to, and then look for treatment options in pairs. Even for the same type of fracture, the treatment options are diverse and require flexibility depending on the level of treatment at the hospital, the doctor’s own expertise, and the patient’s financial situation. Below, several of the most common types of metacarpal fractures will be described. 1, metacarpal neck fracture (boxer’s fracture) This fracture is named because it commonly occurs after a boxer strikes his opponent hard enough to cause his own fracture. However, in our experience, this type of fracture is most common in young people who are bloodthirsty, and after getting annoyed with their girlfriends or parents, they pound the wall or pound the table with a hard fist, causing a fracture. Many people do not think it is a fracture at first, just the back of the hand is swollen some, not too painful, and only after the photo sub had to believe. Some people even come to see the doctor about a month after the injury, when the fracture has basically healed. Most commonly found in the 4th and 5th metacarpals, the fracture often has an angulation to the palmar side and most do not have a rotational deformity. How are these fractures treated? Most metacarpal neck fractures can be treated satisfactorily with manipulation and plaster (or brace) fixation. The main point of manual repositioning is to flex the metacarpophalangeal joint and push the proximal phalanx backward so that the phalanx will reset against the displaced metacarpal head. The finger is then checked for rotational deformity. The metacarpophalangeal joint is kept in flexion at 80-90 degrees by immobilization in an ulnar U-cast. Care is taken not to fix the interphalangeal joint in flexion, but either not to fix it and allow it to flex freely or to fix it in extension. To avoid flexion contracture of the interphalangeal joint. After the cast is fixed, a second film can be taken to see the repositioning. If necessary, another revision is needed. Studies have confirmed that palmar angulation of 30-40 degrees or less does not have a significant impact on function. In other words, even if there is some residual deformity, it is not a big problem. Some foreign scholars do not even reposition the smaller angles and fix them directly in a cast. Advantages: low cost, less hassle. Disadvantages: most of the repositioning cannot obtain anatomical repositioning, but the good thing is that even if it is not anatomical repositioning, it does not affect the function much. Possible sequelae include: bulging of the dorsum of the hand, claw-like deformity of the little finger, inability to bring the little finger together, failure to make a solid fist, etc. When do I need surgery? Multiple metacarpal neck fractures, or cases with large displacements that are not satisfactorily repaired by manipulation, or patients with high requirements for fracture repositioning, may be treated surgically. The first recommended treatment is closed threading, or minimally invasive surgery, which does not affect the blood supply to the fracture end, does not involve extensive surgical debridement, and minimizes the possibility of tendon adhesions. This procedure needs to be supported by intraoperative fluoroscopy, otherwise it is difficult to perform. If intraoperative stable fixation can be obtained, early postoperative activity is possible. Plate fixation has also been chosen, but is rarely needed. 2. metacarpal stem fractures A small amount of dorsal metacarpal angular deformity is acceptable. The most important thing to avoid is rotational deformity, which can lead to two adjacent fingers overlapping each other. Fractures that are not displaced or that can be maintained stable with manipulation can be fixed in a cast. The position of fixation is the same as in the previous pictures. Take care to check for rotational deformity of the finger. During plaster fixation, the radiographs should be reviewed once a week in order to detect the displaced fracture in time. Plate fixation is also an option for multiple fractures or fractures with large displacements. This treatment is reliable, allows early movement and has little impact on function. The disadvantage is the cost and the scarring of the incision on the back of the hand.