An orthopedic surgeon at a destination wedding in South Goa, India, grabbed the groom's shoe with both hands as several of the groom's friends tried to take it back. One of them seized his left ring and little fingers and forced them backward. There was a sudden snap. He still did not let go.
X-rays later showed a long oblique fracture through the shaft of his left fourth metacarpal. The American Academy of Orthopaedic Surgeons describes the metacarpals as the five bones in the palm that "connect the fingers to the hand and wrist." The fourth sits behind the ring finger.
The surgeon, who the report says is its primary author, and his colleagues described the injury in the Journal of Orthopaedic Case Reports in January 2024. They argue that the break came from a mechanism that, to their knowledge, had not been reported in the medical literature.
A Playful Wedding Custom Turned Into a Tug-of-War
The injury happened during Joota Chori, a lighthearted Indian wedding tradition. As the report explains, the bride's sisters traditionally hide the groom's shoes while he takes them off for the marriage rituals, and he gets them back only after paying a hefty sum. The bride's friends often join in, while the groom's friends try to stop the theft.
The custom is meant to be fun, but it can turn physical. The authors, from Seth GS Medical College and KEM Hospital in Mumbai and Kasturba Medical College in Mangaluru, note that the ritual traditionally involved women, and that growing involvement by men in recent years has "amplified the physical intensity."
In this case, four or five of the groom's friends ambushed the surgeon. One "caught hold of his left 4th and 5th finger and twisted it open in extension," the report says. After the snap, he held onto the shoe, broke free with help from teammates, and ran off with it. The group later traveled 40 kilometers to Madgaon for an X-ray.
Why This Break Surprised the Surgeons Who Studied It
Most metacarpal fractures, the authors note, come from a direct blow or crush injury. A long oblique or spiral pattern is usually linked to twisting forces. Punches, by contrast, often produce a boxer's fracture, a break in the fifth metacarpal that the AAOS says commonly comes from striking a hard object with a closed fist.
This injury did not fit neatly into those categories. The authors propose that forcing the fingers backward, known as hyperextension, can produce a long oblique shaft fracture without a twisting force. "Pure hyperextension injury represents an uncommon mechanism leading to long oblique metacarpal shaft fractures," they wrote.
Their explanation centers on the grip. While he clutched the shoe, the muscles of his hand and forearm were contracting hard. The authors write that the tightly contracted small muscles between the hand bones left the fourth metacarpal "sandwiched in a tight closed compartment while facing bending forces." When his fingers were suddenly forced back, that bending force broke the bone on a long diagonal.
The authors present this as a theory based on a single injury, not a finding confirmed in laboratory or larger clinical studies. They suggest it may also apply to rugby-style tussles over a ball. The AAOS lists falls, crush injuries, twisting injuries and direct contact in sports as common causes of hand fractures. A wedding tug-of-war over footwear is not on that list.
No Surgery, but Eight Weeks to Heal
The fracture was treated without surgery. A colleague back at the hotel applied an ulnar gutter slab, a splint along the little-finger side of the hand, with the ring and little finger knuckles held at 90 degrees of flexion.
After two weeks, the slab was replaced with a removable splint. At eight weeks, X-rays showed complete healing, and the authors report "near complete functional recovery."
That course is broadly in line with general guidance. The AAOS says many hand fractures are treated with a cast, splint, or brace, often for three to six weeks, while fractures that break through the skin may need surgery. MedlinePlus adds that surgery may be recommended when the bones are shifted out of place, the fingers do not line up, or the break extends into a joint. The AAOS also notes that immobilization can leave the hand stiff, so therapy is often needed afterward.
The report, also indexed on PubMed, is more than two years old, but its central point about how a grip can turn into a fracture has not been tested in larger studies.
Beyond the mechanism, the authors make a practical recommendation: "Grand Indian weddings should be equipped with relevant first aid equipment for musculoskeletal injuries." Basic first aid for a suspected broken bone includes keeping it still with a splint or sling until it can be examined.
For anyone caught in a similar tug-of-war, the lesson is simpler. Holding on through a snap may win the game, but adrenaline and a cheering crowd can make it easy to ignore pain. Warning signs of a hand fracture, according to the AAOS, include swelling, bruising, tenderness, deformity, an inability to move a finger, a shortened finger, or a finger that crosses over its neighbor when making a fist. Anyone with those symptoms after a hand injury should have it checked, since some fractures need realignment to heal properly.
Key Questions Answered
What happened to the surgeon?
During a Joota Chori tug-of-war at a wedding in South Goa, someone forced his left ring and little fingers backward while he gripped the groom's shoe. He fractured his left fourth metacarpal.
What is Joota Chori?
It is a playful Indian wedding tradition in which the bride's side hides the groom's shoes and asks for money to return them.
Why is the fracture considered unusual?
Long oblique metacarpal fractures are usually linked to twisting. The authors believe this one was caused by hyperextension while the hand muscles were tightly contracted, a mechanism they say had not been reported before, to their knowledge.
How was it treated?
With a splint rather than surgery. X-rays showed complete healing by eight weeks.
What are signs of a broken hand?
Swelling, bruising, tenderness, visible deformity, trouble moving a finger, a shortened finger or a finger crossing over its neighbor when making a fist.
When was the case published?
The report appeared in the Journal of Orthopaedic Case Reports in January 2024.
Published by Medicaldaily.com
