You or someone in your circle, or one of your patients, may have a fracture of the thumb bone (the first metacarpal), a Bennett’s fracture, or another type. You are likely to have many questions about the treatment, potential complications, and healing time for this type of hand fracture.
As a physiotherapist, I rely on my professional experience and research in medical publications to address the most common questions about a broken thumb.
If you still have questions after reading this article, feel free to ask them in the comments, and I will be happy to answer!
Enjoy your reading 🙂!
Last update: August 2023
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What are the different types of thumb fractures?
The thumb is composed of:
- 2 phalanges (= 2 bones):
- P1: the one closest to the wrist = proximal phalanx
- P2: the one closest to the fingertip = distal phalanx.
- 1 metacarpal bone: the base of the thumb, shown in red in the image below. It is the part that articulates with the bones of the wrist. The metacarpal bone is composed of several parts:
- the head of the thumb metacarpal;
- the shaft of the thumb metacarpal;
- the base of the thumb metacarpal.
A fracture can occur along the different phalanges or the metacarpal bone, but it is more common at the base of the thumb, at the level of the metacarpal.
Fractures of the thumb are named differently based on their location and other characteristics:
- Fracture of the proximal phalanx of the thumb.
- Fracture of the distal phalanx.
- Fractures of the base of the thumb (i.e., the metacarpal bone): often caused by a fall on the hand or a direct blow to the thumb. Among all metacarpal fractures, 2.5% of people will have at least one metacarpal fracture in their lifetime, and in 1/4 of cases, it is a fracture of the thumb metacarpal (Goru 2022).
- Bennett fracture +++: the most common fracture at the base of the thumb. It also involves the trapezium bone and results in joint displacement (dislocation). It is also called a carpo-metacarpal joint fracture (+- dislocation). It is located on the ulnar side of the bone. It is less severe than a Rolando fracture.
- Fracture (+- dislocation) of the metacarpophalangeal joint: between the base of the thumb and P1.
- Rolando fracture: This is an articular fracture (involving the joint), comminuted and multifragmented, with fracture lines in the shape of Y or T. It is located on the radial side of the bone.
And like any fracture, regardless of the affected bone, these fractures can be:
- Displaced (there is a significant gap between the two bone fragments) or non-displaced.
- Open (the skin and various types of tissue are open, revealing the bone) or closed.
- Simple, complex, or comminuted (the bone is broken into multiple fragments).
- Associated or not with ligamentous or nerve injuries.
It is the articular fractures (those involving the wrist joint, via the trapezium bone) that can be a bit more troublesome than others.
The specific type of fracture you have is often written on your medical imaging report or on your medical consultation, emergency department, or hospitalization report.
Broken or Sprained Thumb? Diagnosis
As is often the case, different terms are used in common or medical language to refer to the same things:
- Fractured thumb = broken thumb;
- Sprained thumb = sprain or rupture of one or more ligaments of the thumb. Most commonly, it is a sprain of the ulnar collateral ligament of the thumb.
The symptoms of a fractured thumb are similar to those of a ligament injury:
- Trauma as the cause: falling on the hand or direct trauma to the thumb.
- Sharp pain
- Swelling, edema
- Difficulty in using the thumb, bending the phalanges.
That’s why a radiograph is often performed when these symptoms are present, to make a “differential” diagnosis between a sprain and a fracture.
Especially if the pain is localized near the wrist joint, which requires more specific treatment than a fracture of a distal phalanx, which is non-articular.
Radiography does not allow visualization of a sprain or ligament rupture but can usually detect a fracture.
To visualize a sprain, other imaging tests can be performed, but they may not be necessary because the treatment may not be different afterward.
Moreover, the accuracy of these examinations (including X-ray) may not be optimal to ensure a definite diagnosis of a fracture of a phalanx:
Imaging tests (conventional radiography, MRI, CT scan, and bone scintigraphy) have been considered only moderately accurate for definitive diagnosis in a hospital setting (for fractures of the phalanges, metacarpals, or carpal bones).Krastman 2020
Personally, after a thumb injury, I do not encourage my patients to pursue further investigation with MRIs or ultrasounds if the X-ray was okay. Each professional and patient may have a different stance on this matter.
What is the treatment for a thumb fracture?
Once you have had your X-ray, it will typically be shown to an emergency physician, sports medicine doctor, or orthopedic surgeon (specialized or not in hand injuries) to determine the most appropriate treatment based on:
- The type and location of your thumb fracture
- Any associated injuries
- Your overall health
- Your occupation and leisure activities
Ideally, and if you wish, healthcare professionals will involve you in this decision-making process, weighing the advantages and disadvantages of possible treatments for a thumb fracture:
- Simple precautions without immobilization
- Immobilization with a splint or buddy taping
Regarding Bennett fractures, there is no consensus on their treatment. A recent publication on this subject states:
There is no consensus among orthopedic surgeons regarding the treatment of this fracture. Bennett himself (the one who gave his name to the Bennett fracture) was dissatisfied with the results of these fractures, leaving his patients unable to grasp or lift objects with their hands two years after the injury.Goru 2022
Immobilization, Thumb Splint?
In general, non-displaced and non-articular thumb fractures can be treated with simple immobilization using a thumb splint or orthosis (rarely a cast). Sometimes, custom-made splints are used, while other times, ready-made ones can be purchased (see on Amazon).
At times, a strapping or buddy taping may be suggested for a few days, followed by careful use of the thumb.
Medications or non-medication approaches may be recommended to alleviate pain, especially in the first few days.
A follow-up X-ray is usually done after a few weeks to check if everything is healing properly, after which the thumb can be gradually used “as before.”
How long to keep the splint or immobilization after a thumb fracture? Generally, a shorter duration than for other parts of the body, to avoid joint stiffness. Usually around 2 to 3 weeks, sometimes 4 to 5 weeks, rarely longer. This is referred to as “early mobilization.”
Surgery for a Thumb Fracture?
If the thumb fracture is dislocated and/or severely displaced, surgical treatment is sometimes recommended.
Various surgical techniques can be performed, often using arthroscopy, which involves making very small incisions, eliminating the need for a large scar.
Under anesthesia, the surgeon:
- Reduces the fracture: They manipulate the bones to realign them properly.
- Stabilizes the fracture with hardware such as screws, plates, etc.
Here are the conclusions of a research team that synthesized the knowledge from studies comparing the effectiveness of surgical versus conservative (non-surgical) management after a Bennett fracture:
As this review primarily includes retrospective studies, our main outcome measure concerning post-traumatic arthritis is similar between the operated and non-operated groups.Goru 2022
Our measure of secondary outcome (residual pain) was significantly higher in patients treated without surgery. However, due to the smaller sample size and heterogeneity of these studies, the strength of these results is low.
The treatment of a broken thumb is often done through simple immobilization. Sometimes, surgery is necessary or proposed to facilitate consolidation and recovery.
Rehabilitation, Physical Therapy, and Exercises?
Regardless of the treatment you received for your thumb fracture, your thumb will generally be:
- Slightly stiffer
- Slightly painful
- Slightly weaker
To regain strength, flexibility, and mobility in your thumb, the main focus of treatment is simply to gradually reuse your thumb in all daily activities, based on your pain level and the instructions you were given.
This is why sometimes physical therapy sessions are prescribed. Physical therapists are professionals experienced in supervising hand rehabilitation. Some therapists specialize in hand rehabilitation, but all therapists are initially trained for this type of care.
Your physical therapist will conduct an assessment, ask you questions, and then work with you to develop a treatment plan. The ways that physical therapists practice can vary greatly.
- Some may advise you to come several times a week for exercises at the clinic and/or passive mobilization performed by them.
- Some use a lot of equipment, while others may not use any equipment. If you have undergone surgery, some therapists may massage and mobilize your scars to try to reduce adhesions, while others may not touch them, as adhesions are stretched and mobilized during the movements you perform.
- Others may focus on having you perform short exercises (a few seconds) on your own multiple times a day, or gradually resume daily activities under their occasional supervision. They will also address your questions and provide reassurance. This is the type of treatment I prefer.
It’s up to you to discuss with your physical therapist the type of treatment you prefer, considering their own approach as well 🙂.
The rehabilitation and physical therapy exercises after a thumb fracture will depend more on the current mobility of your joint than on the type of fracture you have had.
How long does it take to recover after a thumb fracture?
The time for bone consolidation after a fracture is often estimated to be around 6 weeks, although there can be significant variability depending on factors such as individual differences, the location and type of fracture, etc.
However, bone consolidation time does not necessarily mean “recovery time.”
Your thumb fracture may have consolidated well in a few weeks, but you may not have regained full functionality of your thumb as before.
Conversely, you may experience a delayed consolidation (or even a non-union, where the bones do not heal together) and still be able to use your thumb as before.
I have not found specific data on how long it takes for people to resume activities like driving, sports, or everyday thumb use after a thumb fracture.
Based on my experience, the general timeline for recovery after a thumb fracture is as follows:
- A few days to a few weeks to no longer experience pain.
- A few days to resume driving (a car, a bike).
- Several weeks to fully re-use the hand in daily activities as before.
- At least 2 to 3 months to gradually return to sports that require “strong” fingers (e.g., handball, judo), and often even longer.
Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !
If you feel the need to learn more about the recovery period after this type of fracture, I wrote this guide in eBook format:
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To support this article, I have identified scientific publications on the diagnosis, treatment, and healing time of a thumb fracture:
Here are the publications I have relied upon, in addition to my professional experience.
Goru P, Haque S, Verma GG, Mustafa A, Ebinesan A. Bennett’s Fracture Management: A Systematic Review of Literature. Cureus. 2022 Nov 10;14(11):e31340. doi: 10.7759/cureus.31340. PMID: 36514567; PMCID: PMC9733783.
Faruqui S, Stern PJ, Kiefhaber TR. Percutaneous pinning of fractures in the proximal third of the proximal phalanx: complications and outcomes. J Hand Surg Am. 2012 Jul;37(7):1342-8. doi: 10.1016/j.jhsa.2012.04.019. PMID: 22721457.
Krastman P, Mathijssen NM, Bierma-Zeinstra SMA, Kraan G, Runhaar J. Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update. BMC Musculoskelet Disord. 2020 Jan 7;21(1):12. doi: 10.1186/s12891-019-2988-z. PMID: 31910838; PMCID: PMC6947988.
By Nelly Darbois
I love to write articles that are based on my experience as a physiotherapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as a physiotherapist and scientific editor for my own website, where you are.