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  • Randon Hall, MD

NBA Lakers - Insight on Josh Hart's Surgically Repaired Hand


Josh Hart Sustains Fractured Hand In PRACTICE

Josh Hart sustained a fourth metacarpal fracture this past Wednesday, February 28th, and had surgery two days later. It is reported that Hart's injury occurred in practice. The details are lacking in the reports, but based on the need for surgery, there are a few different things that might have happened. A fracture can occur anywhere along the bone, but the most frequent locations are the head, neck, shaft or base (pictured above). I can think of a few ways that the injury may have occurred in this situation. For example, Hart may have fallen on an outstretched hand, he may have struck something with the hand or someone may have struck his hand with an elbow.

Metacarpal Fracture Insights

The metacarpal bones are located below the large knuckles when the hand is in a fist, and the 4th metacarpal is the ring finger. A few different types of fractures could have occurred, leading to surgery. One example is a spiral fracture of the shaft of the metacarpal (photo below). It is possible to treat these types of fractures without surgery, but they have the tendency to slip and can become shortened. Another example is a metacarpal neck fracture (photo below), which occurs just below the large knuckle. Usually these occur with a forward bend to the bone causing a deformity over the back of the hand. Again, these fractures can be treated non-operatively, but it depends on the angulation of the fracture. An important precaution with hand fractures is to make sure there is no rotational component of the fracture, causing the fingers to cross when one makes a fist. If the rotation is missed and not repaired, an athlete may develop inability to perform certain tasks with the hand.

What is the impact on Josh Hart and the Lakers?

Most likely, Josh Hart either had a metacarpal shaft fracture or a metacarpal neck fracture. Since he needed surgery, he probably had a pin placed in the hand to stabilize the fracture, as shown below. However, it is possible that he was taken to surgery just to have the fracture set and no hardware placed, but that is unlikely. The benefit of surgery in his case, is to allow him to get the hand moving sooner than if a non-surgical approach was taken. The average individual usually would be put in a cast, however, I suspect he will be placed in a custom hand splint, usually made by a hand therapist. Since the fracture would be stabilized, a removable splint would allow him to get started on early physical therapy. Laker fans should not worry. Due to the fact that the fracture is of the metacarpal and not the finger, there will likely be no impact on his dribble or shot in the future. Reports state he should be out for about 4 to 6 weeks.

5th Metacarpal Spiral Shaft Fracture

As mentioned above, spiral shaft fractures are at risk of shortening and have to be watched closely.

Photo by David Couch under creative commons

Fifth Metacarpal Neck Fracture (Boxer's Fracture)

This fracture is called a Boxer's Fracture, as it usually occurs from punching something with a closed fist. Surgical recommendations depend upon the angle at which the fracture is positioned.

Photo by Chuck D under creative commons

Surgical Repair of Metacarpal Fracture

Seen below is surgical stabilization of the fracture site with a metal pin. Typically a portion of the pin is left outside of the body so it can easily be removed in the future. Usually the pin is removed once enough healing has occurred to continue to keep the fracture in an acceptable position.

Photo by Masahiko Ohkubo under creative commons

Copyright 2017 The Sports Source, LLC

Dr. Randon T. Hall

A sports medicine physician with a passion to educate. My mission is to provide clear, concise and up to date education to athletes and sports fans for a better understanding of sports related health issues.

 

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