Randon Hall, MD
MLB Giants - 3 Possibilities of Bumgarner's Hand Fracture
Bumgarner Sustains Fractured Hand In SprinG Training
Madison Bumgarner sustained a hand fracture in a spring training game this Friday. It is reported that injury occurred due to a line drive that his pitching hand. The details are lacking in the reports, but he is being evaluated and it is not clear if he will need surgery. He potentially could have a fracture to the fingers themselves which would be great news, however it is more likely that he has a fracture to the metacarpal bone which would be exposed out of the glove. A fracture can occur anywhere along the bone, but the most frequent locations are the head, neck, shaft or base (pictured above). Typically a plain x-ray can determine the extent of the fracture.
WHY MIGHT A Metacarpal Fracture NEED SURGERY?
The metacarpal bones are located below the large knuckles when the hand is in a fist. A few different types of fractures could have occurred, potentially needing 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 MOST LIKELY SURGERY TO HAVE?
The most common fractures to need surgery would be a metacarpal shaft fracture or a metacarpal neck fracture. An athlete probably would have a pin placed in the hand to stabilize the fracture, as shown below. However, it is possible that an athlete can be taken to surgery just to have the fracture set and no hardware placed, but that is unlikely. The added benefit of surgery in some cases, is to allow an athlete to get the hand moving sooner than if a non-surgical approach was taken. The average individual usually would be put in a cast or placed in a custom hand splint, usually made by a hand therapist. Since the fracture would be stabilized, a removable splint would allow an athlete to get started on early physical therapy. Generally return to play is in about 4-6 weeks once healing is seen on x-ray and pins can be removed.
What is the impact on BumGarner?
Most likely, Bumgarner has a finger fracture or a metacarpal shaft fracture. Due the fact that this is his throwing hand, I suspect he will be out for about 4 to 6 weeks, even if he does not need surgery. However we will know more when details are released!
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