Fourth Metacarpal Break

I recently fractured the fourth metacarpal bone in my left hand in a fall. The finger above the break is now recessed toward my palm. I’ve been told that it will heal fine, but that without surgery the alignment will not change. I want to avoid surgery, but I’ve already had pulley issues with my hand. Will the misaligned finger impact my climbing?

— CW, Rock and Ice Forum

The angulation is likely to cause pulley issues for the simple reason that the tendon is now loading the pulley in an abnormal fashion. How much more it
makes the pulley prone to injury long-term is not easy to say.

If there is any rotation or angulation of the fracture site when it sets, you are likely to get flexion approximation, whereby finger flexion (making a
fist) will cause the ring finger to draw toward one of its neighbors.

Ultimately I doubt the situation will have much long-term effect beyond annoyance. On the flip side, your pinkie and ring finger in a stacked mono will
feel oddly aligned and your Vulcan salute will take on a certain je ne sais quoi. For now I would just wait and see how it goes. If it becomes
an issue, you can always book the surgeon at a later date with no drawback aside from deductibles and down time.

This article was published in Rock and Ice 222 (November 2014).