Skip to content

Patients › Hand

掌骨骨折（包括拳击手骨折）

PDF In-depth PDF

A broken hand bone in the palm — including the common boxer's fracture — how it is treated, the rotation check that matters most, and recovery.

拳击手用紧握的拳头击打速度球。
掌骨骨折——包括小指指关节常见的“拳击手骨折”——通常继发于拳击或手部直接撞击。 Kieran Hirpara 4.0

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您正在感受到的症状

掌骨骨折是指手部掌骨（连接手腕与手指的长骨，即您能触摸到的指关节处骨骼）中的一根发生断裂。最常见的类型发生在拳击之后，累及小指指关节后方的骨骼。这种情况极为常见，以至于有一个俗称：拳击手骨折。

通常会有一个明显的受伤时刻：向坚硬物体出拳、跌倒时手掌着地，或遭受挤压或扭伤。受伤后，手背立即出现疼痛、肿胀和瘀伤，与对侧相比，指关节可能显得扁平或“凹陷”。握拳时疼痛，且抓握力感觉减弱。有些人会注意到，当尝试将手握成拳头时，某根手指似乎交叉或指向相邻的手指；这种扭转至关重要，是我们检查的主要事项之一。

实际发生了什么

您有五根掌骨，每根分别延伸至一根手指和拇指。骨折可能发生在颈部（紧邻指关节后方，即典型的拳击手骨折部位）、骨干（骨的中段）或基底（靠近手腕处）。骨折后，断端可能形成角度、缩短或扭转。

一定程度的角度通常是可以接受的，因为手部具有较强的代偿能力，尤其是环指和小指的掌骨，能够耐受相当程度的弯曲而不引起实际问题，因为这些指关节天生活动度更大。手部难以耐受的是扭转（我们称之为旋转）。即使骨折处存在少量旋转，也会导致握拳时该手指向相邻手指偏斜，使得手指无法整齐并拢。因此，您握拳时手的外观比单独的X线角度更能反映情况。

我们能做什么

Kieran Hirpara 医生是 Mater Private Hospital Rockhampton 的上肢外科医生，负责指导您的护理，从初次评估一直持续到康复阶段。患者通常由其全科医生（GP）转诊至我们的诊所；如果物理治疗师建议您就诊，您仍需获得全科医生的转诊才能符合 Medicare 报销资格，随后我们将确认诊断并选择适合您需求的方案。

好消息是，大多数掌骨骨折无需手术即可良好愈合。

对于大多数病例（包括大多数拳击手骨折），答案很简单： 支撑和早期活动。根据骨折情况，我们可能会使用轻质夹板、石膏，或仅将受伤的手指与相邻手指进行邻指固定（buddy-strapping），然后鼓励您尽早开始轻柔地活动手部。早期活动是有意为之的：它可以防止手部僵硬，且研究表明，对于典型的拳击手骨折，简单的固定配合早期活动与较重的石膏固定效果相当 [4, 5]。

手术仅保留给那些若不干预则预后不佳的骨折。手术的主要指征包括：旋转（扭转）的手指、角度严重异常或短缩的骨骼、多根掌骨同时骨折、累及关节的骨折，或骨折处有开放性伤口。当我们进行固定时，选项包括经皮置入的小钢丝（K-wires），或通过切口置入的小钢板和螺钉。许多此类手术可在患者完全清醒的状态下进行，通过局部麻醉使手部麻木，同时您保持清醒且舒适，这使我们能够在手术台上请您活动手指，并在结束手术前确认旋转已得到纠正。

预期情况

大多数掌骨骨折在四至六周左右愈合，手部很快即可恢复大部分正常活动。即使骨骼愈合时伴有轻微弯曲，指关节可能看起来不如以前突出，但手部通常能完全正常运作。

无论是否接受手术，保护治疗效果的关键在于术后的手部活动：轻柔、早期进行，并在必要时由手部治疗师指导。我们重点关注的并发症包括僵硬（最常见）、残余扭转或弯曲（畸形愈合），以及偶尔出现的指骨完全伸直功能轻微受限。通过早期活动预防僵硬远比后期治疗更容易，因此我们建议您尽早开始活动，而非拖延。

何时就医

  • 任何畸形，或握拳时手指越过相邻手指：这种扭转需要尽快评估，因为它是矫正或固定骨骼的关键原因。
  • 指关节处皮肤上的伤口或破损，尤其是在出拳击中他人嘴部之后：牙齿可能引入严重感染，这需要紧急医疗处理。
  • 剧烈疼痛、明显肿胀、麻木，或手指看起来苍白或暗红：请毫不拖延地接受复查。
  • 受伤后数周内手部变得僵硬而非更灵活：早期手部治疗能带来实质性差异。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您做出自身治疗决策所需的深度。掌骨骨折值得额外阅读，因为其中大多数根本无需手术，且最令患者担忧的畸形——即变平的指关节——恰恰是手部耐受性最好的畸形。

为何成角畸形可被耐受，且在不同手指间存在差异

掌骨颈骨折通常会导致掌骨头向掌侧倾斜，从而使指关节失去其原有的隆起。这种外观显得异常，容易被误判为需要矫正。

决定其临床意义的关键在于腕端相应关节的储备活动度。食指和中指的掌骨基底实际上处于固定状态，因此该处的成角畸形难以得到代偿。无名指和小指的掌骨则位于活动度较大的关节上，允许相当大的旋转，从而能够吸收相当程度的成角畸形而不造成功能丧失。

正因如此，小指掌骨的拳击手骨折（最常见的一种）比相隔两根手指的相同损伤能耐受更多的成角畸形，且该处外观显著的畸形通常无需手术即可处理。

旋转畸形才是真正重要的畸形

旋转畸形是例外情况，值得深入理解，因为它在X线片上容易被漏诊。掌骨若以扭转状态愈合，会导致手指在握拳时越过相邻手指——即出现剪刀样畸形，这会真正损害抓握功能，且不会随时间推移而代偿。

评估旋转畸形的方法是让患者握拳，观察指甲是否对齐以及手指是否呈汇聚状指向，而非通过测量X线片来评估。若骨折在X线片上角度可接受，但查体可见剪刀样畸形，则需予以矫正；反之则通常无需处理。

在采用固定术的情况下，证据较为有限

对于确实需要手术的骨折，髓内螺钉固定术（即从指关节沿骨干置入螺钉）因其避免了在伸肌腱下方放置钢板而日益普及。一项回顾性研究纳入了1,014例患者，结果显示掌骨骨折髓内螺钉固定术后的并发症相对少见 [1]。

与该技术的高普及度相比，其对比性证据较弱。一项早期针对502例患者的综述得出结论：髓内固定术可能在某些掌骨骨折的治疗中发挥作用，但基于现有研究无法得出明确的推荐意见 [2]。

上述两种说法可以同时成立：该技术是安全的，且尚未被证明具有优越性。鉴于此类骨折中的大多数在不进行手术的情况下预后良好，更具决定意义的决策仍然是是否进行手术，而非选择何种内固定物。

畸形愈合可纠正，这改变了决策考量

若骨折愈合位置不佳并导致真正的功能障碍，可采用矫形截骨术。矫形截骨术几乎总能顺利愈合，大多数患者表现为畸形改善或矫正以及手指活动度提升——尽管综述指出，许多患者尽管有所改善，仍保留一定程度的活动受限 [3]。

对于临界病例，这是支持非手术治疗的合理论据。现在进行手术的替代方案并非“接受任何结果”，而是“在最终被证明需要手术的那部分人数较少的群体中，择期进行手术”，且该手术愈合可靠。

参考文献

[1] Anene CC, Thomas TL, Matzon JL, Jones CM. 掌骨骨折髓内螺钉固定后的并发症：系统综述。J Hand Surg Am. 2024;49(10):1043.e1-1043.e16. https://doi.org/10.1016/j.jhsa.2023.01.012

[2] Corkum JP, Davison PG, Lalonde DH. 掌骨骨折髓内固定最佳证据的系统综述。Hand (N Y). 2013;8(3):253-60. https://doi.org/10.1007/s11552-013-9531-8

[3] Freeland AE, Lindley SG. 指掌骨和指骨的畸形愈合。Hand Clin. 2006;22(3):341-55. https://doi.org/10.1016/j.hcl.2006.03.001

[4] van Aaken J, Fusetti C, Luchina S, Brunetti S, Beaulieu JY, Gayet-Ageron A, et al. 采用软包裹/邻指胶带固定与复位石膏固定治疗第五掌骨颈骨折：一项前瞻性、多中心随机试验的结果。Arch Orthop Trauma Surg. 2015;136(1):135-42. https://doi.org/10.1007/s00402-015-2361-0

[5] Poolman RW, Goslings JC, Lee J, Statius Muller M, Steller EP, Struijs PA. 闭合性第五（小指）掌骨颈骨折的保守治疗。Cochrane Database Syst Rev. 2005;(3):CD003210. https://doi.org/10.1002/14651858.cd003210.pub3

Reviewed by Dr Kieran Hirpara · 23 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.