Hand & Wrist Fractures

Hand Fractures

Hand fractures occur when any of the bones in the hand are broken.

Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.

Signs and symptoms of a broken bone in the hand include:

  • Swelling over the site of the fracture
  • Pain and tenderness
  • Deformity when the hand looks out of shape
  • Inability to move the finger/hand, this can be due to pain or deformity or a combination of both
  • Shortened finger when compared to the normal side
  • Finger crosses over its neighbor when making a partial fist (Fig 1)
  • Depressed knuckle or absence of a knuckle

A depressed knuckle is often seen in a “boxer’s fracture.” This is a fracture of the fifth metacarpal, the long bone below the little finger.

The fingers should all point towards the base or bottom of the thumb at the wrist ( diagram courtesy of AO Foundation)

 

Cases of fractures can present early or late. In early and less severe cases, the function is still acceptable.

When you see a surgeon with a possible fracture, the hand will be examined to checkcheck the position of the fingers and the condition of the skin. The examination may include some range of motion tests and an assessment of feeling in the fingers. This will ensure that there is no damage to the nerves.

X-rays are the investigation of choice to assess the fracture. Sometimes CT scans are included especially those with a possibility of joint involvement.

Understanding Wrist Fracture and Hand Fracture

Discover how to distinguish between a wrist fracture and a hand fracture, the unique challenges each type presents, and the best approaches for healing. Get a clear perspective on fracture treatment and learn how our hand specialists can help you get back on track.

Non-Surgical Treatment

Some fractures can be realigned by manipulating them without surgery. A cast, splint or traction devices can be applied to immobilize the bones and hold them in place. This manipulation and reduction process is usually assisted by the use of live imaging using an image intensifier. This will allow the surgeon to check the position “on-–the-go”
The cast will probably extend from the fingertips down past the wrist almost to the elbow. This will ensure adequate immobilization and give the fracture the best stability for adequate healing.

A second set of X-rays will probably be needed about a week later. These X-rays are used to ensure that the bones have remained in the proper position.

The cast will be worn for three to six weeks. Gentle hand exercises can probably be started after three weeks. Afterward, the finger may be slightly shorter, but this should not affect the ability to use the hand and fingers.

Surgical Treatment

Some Fractures are unstable and cannot be held in place despite reduction and stabilization with casts and splints. Fractures that break through the skin (open fractures) or are dirty nearly always need surgery. Surgery is performed to fix the bone and soft tissue back into place so that everything can heal as well as it can. There might be some loss of function depending on the degree of injury or loss of bone and tissue.

After the bone has healed, the surgeon may remove the implants or may leave them in place.

Hand Therapy is an important part of the process of healing and return to normality. Joint stiffness may be experienced because of the long immobilization period or from injury to the soft tissues and post-surgery. Exercises can help restore strength and range of motion. The Hand Surgeon or the Hand Therapist will teach you the process of therapy and conduct sessions to help you achieve a good result.

As we know from one of our founders of Hand Surgery,

“Hand fractures can be complicated from no treatment, stiffness from overtreatment, and both deformity and stiffness from poor treatment”

A.B Swanson 1970

Some of the surgical techniques and implants used in fracture fixation in the hand
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