Now that the Dallas Cowboys have clinched the NFC East title, fans are hopeful that their star running back DeMarco Murray is primed for a deep playoff run. So how might his surgically-repaired left hand hold up in the coming weeks? Dr. Alan Jones, the medical director of orthopaedic trauma services at Baylor University Medical Center at Dallas, was not involved in Murray’s treatment. But he has extensive experience treating the type of injury the NFL’s leading rusher sustained. Dr. Jones penned the following post.
The fracture that Dallas Cowboys’ running back DeMarco Murray was reported to have sustained was of the fourth metacarpal. The metacarpals are the bones in the hand that span from your knuckle to the wrist. The fourth metacarpal is the one that corresponds to your ring finger. It is somewhat protected, since it has metacarpals on each side (the third and the fifth). Fractures of the metacarpal bones are common, with the most common one involving the fifth, or small finger, metacarpal. Metacarpal fractures are typically painful, especially with things that place stress on the involved bone, such as the power grip needed to hold a football.
Not all metacarpal fractures need surgery, but those patients with severe displacement, those who wish to have an earlier return to active use and those who cannot wear a cast or brace may be best treated with surgery. According to media reports, Murray underwent surgery on Monday of last week.
Surgery to repair a metacarpal fracture involves two steps: First, the fracture is realigned or “reduced.” Next, the bone is stabilized, most commonly with either pins or a plate and screw construct. Pin fixation can be done with limited or minimal incisions, but typically require removal later when the bone has healed. Plate fixation requires a bigger, open incision for bone repair. It has been reported that Murray had a plate and eight screws inserted in his hand.
With either type of repair, the pins or plates used serve only to keep the bone aligned until it heals — they are not a replacement for the bone. Contrary to some reports, the bone once repaired is not stronger than it was prior to injury, or even close to normal bone strength until a significant amount of bone healing has occurred. Even with plates and screws, the bone is much weaker and prone to disruption of the repair until healing has occurred. Once completely healed, the bone and fixation composite may, however, be as strong or even stronger than the uninjured bone.
Metacarpal fractures typically heal in about six weeks with or without repair. It is important to note that the strength of a surgical repair is about the same for the first few weeks, so that even though the skin incision may be healed, the risk of re-injury of the bone may in fact not be lessened until four or more weeks after surgery.
Short-term consequences of a metacarpal fracture include pain, loss of grip strength and stiffness in the hand and fingers. Long-term prognosis is overall quite good, but full range of motion and grip strength may take several months to return.
A glove and protective plastic shell will somewhat protect the incision and repair from a direct blow, but any immobilization device, such as a cast or brace that would completely protect the repair, would impede function of the hand to a point that would preclude play for a ball handler in football.