What are the common causes of hand fractures. How can you identify the symptoms of a broken hand. What treatment options are available for hand fractures. When is surgery necessary for a hand fracture. How long does it take for a hand fracture to heal.

Understanding Hand Anatomy and Common Fracture Types

Hand fractures are breaks in the bones of the hand, which can occur in various locations. To better understand these injuries, it’s important to familiarize ourselves with the hand’s anatomy:

• Phalanges: The small bones that form the fingers and thumb (two in the thumb, three in each finger)
• Metacarpals: The five bones in the palm that connect the fingers to the wrist

What is the most common type of hand fracture? The fifth metacarpal fracture, often called a “boxer’s fracture,” is the most frequently seen hand fracture. It affects the bone supporting the little finger, typically occurring near the knuckle joint.

Causes of Hand Fractures

Hand fractures can result from various incidents, including:

• Falls
• Crush injuries
• Twisting injuries
• Direct contact in sports
• Punching hard objects (especially in the case of boxer’s fractures)
• Motor vehicle accidents

Recognizing the Signs and Symptoms of a Hand Fracture

How can you tell if you have a hand fracture? Look out for the following signs and symptoms:

• Swelling and bruising around the injured area
• Tenderness or pain, especially when touching or moving the affected part
• Visible deformity of the hand or fingers
• Difficulty moving the affected finger
• Shortened appearance of the injured finger
• “Scissoring” effect when making a fist (injured finger crossing over its neighbor)
• Sunken or depressed knuckle (particularly in boxer’s fractures)

If you experience any of these symptoms following a hand injury, it’s crucial to seek medical attention promptly for proper diagnosis and treatment.

Diagnostic Procedures for Hand Fractures

How do doctors diagnose hand fractures? The diagnostic process typically involves two main steps:

1. Physical Examination

During the physical exam, your doctor will:

• Ask about your symptoms and how the injury occurred
• Inspect your hand for visible signs of injury, such as swelling, bruising, or deformity
• Check for finger overlapping and joint stability
• Assess your range of motion
• Evaluate tendon function
• Test for numbness, which could indicate nerve damage

2. X-ray Imaging

X-rays are essential for confirming the diagnosis and determining the extent of the fracture. They provide clear images of the bone structure, allowing the doctor to:

• Identify the exact location of the fracture
• Assess the severity of the break
• Determine if there are multiple fractures
• Check for any displacement or angulation of the bone fragments

In some cases, additional imaging tests like CT scans or MRIs may be necessary for a more detailed view of the injury.

Non-Surgical Treatment Options for Hand Fractures

Can hand fractures heal without surgery? In many cases, yes. Non-surgical treatment is often sufficient for hand fractures that are stable and well-aligned. The primary goals of non-surgical treatment are to realign the bone fragments (if necessary) and immobilize the fracture to allow proper healing.

Closed Reduction

What is a closed reduction? It’s a procedure where the doctor manually realigns the bone fragments without making an incision. This is typically done under local anesthesia and is followed by immobilization.

Immobilization Techniques

Depending on the fracture’s location and severity, your doctor may recommend one of the following immobilization methods:

• Cast: A rigid external covering that extends from your fingertips to near your elbow
• Splint: A removable support that allows for some movement
• Brace: A supportive device that provides stability while allowing limited movement
• Buddy strapping: Taping the injured finger to an adjacent healthy finger for support

How long does immobilization last? The duration varies depending on the fracture’s severity and location, but it typically ranges from 3 to 6 weeks.

Follow-up Care

Your doctor will likely schedule a follow-up appointment 1 to 2 weeks after the initial treatment to:

• Take new X-rays to ensure proper healing
• Adjust the immobilization device if necessary
• Address any concerns or complications

Surgical Interventions for Complex Hand Fractures

When is surgery necessary for a hand fracture? Surgical intervention may be required in the following situations:

• Severely displaced or unstable fractures
• Open fractures (where the bone has broken through the skin)
• Fractures involving the joint surface
• Multiple fractures
• Fractures that fail to heal properly with non-surgical treatment

Common Surgical Techniques

What surgical methods are used to treat hand fractures? Some common techniques include:

• Open reduction and internal fixation (ORIF): The surgeon makes an incision to directly access the broken bone, realigns the fragments, and secures them with pins, plates, or screws.
• External fixation: Pins or wires are inserted through the skin and into the bone fragments, then connected to an external frame for stability.
• Percutaneous pinning: Pins are inserted through small incisions to hold the bone fragments in place.

The choice of surgical technique depends on the fracture’s characteristics and the surgeon’s expertise.

Rehabilitation and Recovery After Hand Fracture Treatment

How long does it take to recover from a hand fracture? The recovery timeline varies depending on the fracture’s severity and the treatment method, but most hand fractures heal within 6 to 8 weeks.

Physical Therapy

Physical therapy plays a crucial role in hand fracture recovery. Your therapy program may include:

• Range of motion exercises
• Strength training
• Flexibility exercises
• Desensitization techniques for scar tissue
• Activities to improve fine motor skills

When does physical therapy begin? Gentle hand exercises often start around 3 weeks after the injury, but your doctor will provide specific guidance based on your individual case.

Home Care and Precautions

To support your recovery at home:

• Follow your doctor’s instructions regarding cast or splint care
• Keep the affected hand elevated to reduce swelling
• Apply ice as directed to manage pain and inflammation
• Take prescribed medications as instructed
• Avoid activities that could re-injure your hand
• Attend all follow-up appointments

Potential Complications and Long-Term Outcomes of Hand Fractures

While most hand fractures heal well with proper treatment, complications can occur. What are some potential complications of hand fractures?

• Malunion: The bone heals in an incorrect position, potentially affecting hand function
• Nonunion: The bone fails to heal properly
• Joint stiffness: Reduced range of motion in nearby joints
• Osteoarthritis: Premature wear and tear of the affected joint
• Tendon adhesions: Scar tissue formation affecting tendon gliding
• Nerve or blood vessel damage: Can lead to numbness, weakness, or circulatory problems

How can these complications be prevented or managed? Early diagnosis, appropriate treatment, and diligent follow-up care are key to minimizing the risk of complications. If complications do arise, your doctor may recommend additional treatments, such as:

• Extended physical therapy
• Corrective surgery
• Pain management techniques
• Assistive devices to improve function

Long-Term Prognosis

What is the long-term outlook for patients with hand fractures? With proper treatment and rehabilitation, most people recover well from hand fractures and regain full or near-full function of their hand. However, factors such as the severity of the initial injury, the patient’s age, and compliance with treatment can influence the outcome.

Some patients may experience minor residual symptoms, such as:

• Occasional stiffness or aching, especially in cold weather
• Slight loss of grip strength
• Minor deformity (e.g., a slightly prominent knuckle)

Regular follow-up with your doctor and continued hand exercises can help maintain and improve hand function over time.

Prevention Strategies for Hand Fractures

While not all hand fractures can be prevented, there are steps you can take to reduce your risk. How can you protect your hands from fractures?

General Safety Measures

• Use proper protective equipment when participating in sports or high-risk activities
• Wear work gloves when handling heavy objects or operating machinery
• Practice proper lifting techniques to avoid dropping heavy items on your hands
• Be cautious on slippery surfaces to prevent falls
• Maintain good bone health through proper nutrition and exercise

Sport-Specific Precautions

For athletes and sports enthusiasts, consider these additional tips:

• Use appropriate hand wraps and gloves for combat sports
• Learn proper punching techniques to reduce the risk of boxer’s fractures
• Wear wrist guards for activities like skateboarding or inline skating
• Use padded gloves for sports like hockey or lacrosse

Workplace Safety

In occupational settings, follow these guidelines:

• Adhere to all workplace safety protocols
• Use safety guards on machinery and power tools
• Wear appropriate personal protective equipment (PPE)
• Report any unsafe conditions to your supervisor

By implementing these preventive measures, you can significantly reduce your risk of experiencing a hand fracture.

Advances in Hand Fracture Treatment and Future Directions

The field of hand surgery and fracture treatment continues to evolve. What are some recent advancements in hand fracture management?

Innovative Surgical Techniques

• Minimally invasive procedures: Smaller incisions lead to faster recovery and less scarring
• 3D-printed implants: Custom-made implants for complex fractures
• Bioabsorbable implants: Materials that dissolve over time, eliminating the need for implant removal

Advanced Imaging and Planning

How is technology improving fracture diagnosis and treatment planning?

• High-resolution CT scans: Provide detailed 3D images of the fracture
• Computer-assisted surgical planning: Allows surgeons to plan procedures with greater precision
• Augmented reality in surgery: Helps surgeons visualize complex anatomy during procedures

Enhanced Rehabilitation Techniques

What new approaches are being used in hand fracture rehabilitation?

• Virtual reality therapy: Engages patients in interactive exercises to improve hand function
• Biofeedback devices: Provide real-time data on muscle activity and range of motion
• Telerehabilitation: Allows patients to receive guidance from therapists remotely

Future Research Directions

What areas of hand fracture treatment are researchers focusing on?

• Bone regeneration techniques: Using stem cells and growth factors to enhance healing
• Smart implants: Devices that can monitor healing progress and adjust treatment
• Nanotech

  nology in fracture repair: Developing materials that mimic natural bone structure

• Gene therapy: Exploring ways to manipulate genes to accelerate bone healing

These advancements hold promise for improving treatment outcomes and reducing recovery times for patients with hand fractures. As research progresses, we can expect to see even more innovative approaches to managing these common injuries.

Hand Fractures – OrthoInfo – AAOS

A hand fracture is a break in one of the bones in the hand. This includes:

• The small bones of the fingers (phalanges)
• The long bones within the palm (metacarpals)

A broken hand can be caused by a fall, crush injury, or twisting injury, or through direct contact in sports.

In many cases, a hand fracture will heal well with nonsurgical treatment. Depending on the type and location of the fracture, this may include wearing a cast, splint or buddy straps for a period of time. For more serious fractures or for fractures that do not line up properly, however, surgery may be required to realign the broken pieces of bone and keep them in place until they heal.

The bones in your hand include:

• Phalanges. These are the small bones that form the thumb and fingers. There are two phalanges in the thumb and three in each of the fingers.
• Metacarpals. These are the five bones located in the palm of the hand. The metacarpals connect the fingers to the hand and wrist.

The most common hand fracture is a fracture of the fifth metacarpal — the bone in the hand that supports the little finger. This is commonly called a “boxer’s fracture” and involves the “neck” of the bone, next to the knuckle joint. A boxer’s fracture is caused most often by punching or striking a hard object when your hand is closed in a fist. It can also be caused by a fall, motor vehicle accident, or other trauma.

The bones of the hand. A fracture can occur in the middle of a bone or at the end, near the joint.

Reproduced from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

Signs and symptoms of a hand fracture may include:

• Swelling
• Bruising
• Tenderness or pain
• Deformity
• Inability to move the finger
• Shortened finger
• The injured finger crossing over its neighbor (scissoring) when making a fist

In the case of a boxer’s fracture, the patient’s knuckle may look sunken in or depressed. This is caused by the displacement or angulation of the end, or “head,” of the metacarpal bone.

X-ray of a “boxer’s fracture” in the fifth metacarpal. This common hand fracture can cause the knuckle on the affected finger to appear sunken in or angulated.

Reproduced from Johnson TR, Steinbach LS (eds): Essentials of Musculoskeletal Imaging. Rosemont, IL American Academy of Orthopaedic Surgeons, 2004, p. 347.

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Physical Examination

Your doctor will ask about your symptoms and perform a careful examination of your fingers and hand. During the exam, they may look for:

• Swelling or bruising
• Deformity
• Overlapping of your fingers
• Cuts or lacerations to the skin around the injury
• Limited range of motion
• Joint stability
• Numbness in your fingers, a sign of possible nerve damage

Typically, your doctor will evaluate the tendons in your hand to ensure they are functioning properly and will check for instability in the joint(s) near the fracture.

(Left) This patient’s fractured ring finger cannot be easily detected when his hand is fully extended. (Right) When he makes a partial fist, however, the fracture is more obvious. The fractured ring finger overlaps the adjacent little finger.

Reproduced and adapted from Lehman TP: Hand fractures: current concepts. Orthopaedic Knowledge Online Journal 2012; 10(3). Accessed June 2017.

X-rays

X-rays provide images of dense structures, such as bone. Your doctor may order one or more X-rays to help identify the location and extent of the fracture.

X-rays show a phalanx fracture (left) and a metacarpal fracture (right).

(Left) Reproduced from Kozin SH, Thoder JJ, Lieberman G: Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J Am Acad Orthop Surg 2000;8:111-121. (Right) Reproduced from Johnson TR, Steinbach LS (eds): Essentials of Musculoskeletal Imaging. Rosemont, IL American Academy of Orthopaedic Surgeons, 2004, p. 347.

Nonsurgical Treatment

If a fracture does not line up in an acceptable position, your doctor can often realign the bone fragments by gently manipulating them back into position without making an incision. This procedure is called a closed reduction. A cast, splint or brace may be applied to keep the bones in acceptable alignment while they heal. The cast may extend from your fingertips almost to your elbow to support the bones properly.

Your doctor will probably order a second set of X-rays about 1 to 2 weeks later. This is done to ensure that the bones are healing in the proper position.

Depending on the location and stability of the fracture, you may have to wear the cast for 3 to 6 weeks. Some types of fractures can be protected by wearing a removable splint or by being “buddy strapped” to a non-injured finger next to the injured finger. The non-injured finger acts as a “moving splint” to support the injured finger.

You can usually begin gentle hand exercises after 3 weeks.

Surgical Treatment

Some hand fractures require surgery to realign and stabilize the fracture fragments. Surgery is often necessary for open fractures in which pieces of bone have broken through the skin.

Your doctor may need to make an incision to help reposition the bone fragments into their normal alignment. Small metal devices — such as wires, screws, pins, staples, and plates — may be used to hold the pieces of fractured bone in place.

(Left) X-ray shows a metacarpal fracture of the ring finger. (Right) Here, the fracture has been repaired with a plate and screws.

Reproduced from Kozin SH, Thoder JJ, Lieberman G: Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J Am Acad Orthop Surg 2000;8:111-121.

After surgery, you may have to wear a splint or cast for a period of time to protect the fracture. If the bone changes position during healing, your finger may lose some function. Your doctor will talk with you about when it is safe to begin range-of-motion exercises and to resume your normal activities after surgery.

(Left) X-ray shows fractures in the phalanges of two fingers. (Right) In this X-ray, the fractures have been repaired with screws.

Reproduced from Kozin SH, Thoder JJ, Lieberman G: Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J Am Acad Orthop Surg 2000; 8:111-121.

Because some fractures require prolonged immobilization in a cast or splint, your hand and fingers may become stiff. Your doctor or, in some cases, an occupational therapist, physical therapist or hand therapist, will provide specific exercises to help decrease stiffness and improve function.

Even after carefully following therapy instructions after fracture treatment, some patients may continue to have difficulty with stiffness or a contracture (loss of motion) in the hand. If this occurs, your doctor may recommend a surgical procedure to help restore motion and/or function to your finger. Commonly used procedures include:

• Surgical removal of the retained hardware (such as pins, screws, or plate and screws)
• Tenolysis — freeing up a tendon from scar tissue
• Contracture release — releasing the tight or restrictive supporting structures around the involved joint, including the ligaments and/or joint capsule

Generally, these procedures are used once a fracture has healed and there is no evidence of progress or improvement in the return of function to the injured finger. Your doctor will talk with you about whether you need an additional procedure and, if so, how it may affect your recovery.

With proper treatment, a majority of hand fractures go on to heal with good overall function.

However, some fractures are more problematic than others and can result in poor outcomes. It is important to seek medical care for a hand fracture as soon as possible to ensure the best possible outcome. When treatment is delayed, a hand fracture becomes harder to care for and does not do as well as fractures that are treated promptly.

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Broken Hand: Symptoms and Treatment

The bones of the hand serve as a framework. This framework supports the muscles that make the wrist and fingers move. When one of these hand bones is broken (fractured), it can prevent you from using the hand, wrist and fingers.

Many people think that a fracture is different from a break, but they are the same (see Figure 1). There can be different variations of a fracture, including:

• Stable fracture, when the bone pieces are aligned
• Unstable fracture, when there are bone fragments that have shifted
• Comminuted fracture, when the bone is shattered into many pieces
• Open (compound) fracture, when a bone fragment breaks through the skin. This causes risk of infection.

Figure 1

Examples of a broken hand, specifically the fingers

Figure 2

Examples of plates pins and screws used while a broken hand heals

Causes

A broken hand can occur when enough force is applied to a bone to break it.

Signs and Symptoms

Symptoms of a broken hand can include:

• Pain and stiffness
• Difficulty moving the hand, wrist and/or fingers
• Deformities such as a crooked finger (this is less likely)

Treatment

Medical evaluation and x-rays are usually needed for your doctor to diagnose the fracture and determine the treatment. Depending on the type of fracture, your hand surgeon may recommend one of several treatment methods.

A splint or cast may be used to treat a stable fracture Some unstable fractures, in which the bone has moved, may need to be set and then held in place with wires or pins. This is done without surgery. More serious fractures may need surgery to set the bone and hold the bone fragments together with pins, plates or screws (see Figure 2).

Sometimes, bone may be missing or be so severely crushed that it cannot be repaired. In such cases, a bone graft may be necessary. In this procedure, bone is taken from another part of the body.

Recovery

Sometimes, a bony lump may appear at the spot of the broken bone during recovery known as a “fracture callus.” This is normal, and the lump usually gets smaller over time.

Some problems you may have while your broken hand is healing include:

• Stiffness
• Shifting of bone
• Infection
• Slow healing

To increase your chances of a healthy recovery, do not smoke, and carefully follow your doctor’s instructions. Your doctor may recommend hand therapy to improve the process.

It is important to note that not all fractures completely heal. Because bones have such a close relationship with ligaments and tendons, the hand may be stiff and weak even after the healing process. Some fractures may lead to arthritis down the road. In addition, fractures in children occasionally affect future growth of that bone.

© 2016 American Society for Surgery of the Hand

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you

displaced and non-displaced fracture / dislocation / fissure – Treatment and recovery

The radius of the hand is a long tubular immovable paired bone in the forearm, the body of which has a trihedral shape with three surfaces (anterior, posterior and lateral) and three edges (anterior, posterior and interosseous). It is located next to the ulna, so they are dependent on each other and interconnected. At the bottom, these bones are connected to the bones of the wrist. This is how the wrist joint is formed. Also, the radius is responsible for the mobility of the forearm in the elbow, and the shoulder in the shoulder joint. But according to statistics, with almost the same structure and anatomy, the radius breaks much more often than the ulna.

Types of damage

List of diseases and injuries associated with the radius:

• Inflammation of the periosteum of the radius , as a result, bone tissue nutrition can be seriously impaired, which can lead to gradual destruction of the bone
• Degenerative lesions of the articular surface is a process of thinning of the cartilage tissue from excessive loads (sports, hard work), as a result of which depreciation and slip in the joint deteriorate, increasing friction occurs, leading to the destruction of the joint
• Osteomyelitis – a disease that affects all the tissues that make up the radius (periosteum, bone itself and bone marrow)
• Fractures .

Classification of fractures of the radius:

• Traumatic and pathological (depending on the nature of occurrence)
• Closed and open (depending on skin disorder)
• Oblique, longitudinal, transverse, T-shaped, helical, impacted (in which bone fragments enter (“driven”) into each other) and comminuted (depending on the fault line)

Any type of fracture can be both with displacement of bone fragments and without displacement. A fracture of the radius without displacement most often occurs in the form of a crack in the bone tissue.

It is important to know that diseases and injuries of the radius are often accompanied by similar diseases of the ulna, so if problems are found with one bone, the other should be examined.

Symptoms

The clinical picture of fractures of the radius is as follows:

• Severe pain from wrist to elbow
• Edema and swelling
• Possible hematoma (but not always)
• In displaced fractures, a characteristic crackling sound may appear on palpation of fragments and visible deformity of the wrist joint
• Numbness of fingertips
• Movement in the wrist joint is limited

Which doctor to contact

In the event of a serious injury, the victim should be immediately taken to the traumatology department, where he will be provided with qualified medical assistance.

Specialists to help you:

• Traumatologist-orthopedist
• Surgeon

Diagnostics

Diagnosis for injuries of the radius includes:

• Questioning the patient about the circumstances of the injury
• Initial medical examination
• Imaging:
  • X-ray hand
  • Magnetic resonance imaging
  • Computed tomography

Treatment options

Key methods of fracture treatment: conservative and surgical.

Conservative treatment is prescribed for closed fractures without displacement and is the application of an immobilizing plaster bandage to the injured area after the edema has subsided. Along with this, the doctor prescribes painkillers, anti-inflammatory nonsteroidal drugs and, if necessary, antibiotics. The healing time for uncomplicated fractures varies from 4 to 5 weeks. After removing the plaster, the doctor prescribes rehabilitation treatment.

Surgery is necessary for displaced and comminuted fractures. The main goal of all therapeutic measures is to restore the functionality of the injured hand (as it was before the injury).

Reposition is the main treatment for fractures. The essence of the method is to return the displaced fragments of the radius to their original places and their further fixation. Reposition is closed and open. Open reduction involves making an incision at the site of injury, comparing bone fragments and fastening them with special structures (knitting needles, distraction devices (for example, the Ilizarov apparatus), plates). This operation is called osteosynthesis.

After removing the plaster cast, a rehabilitation course is prescribed, individual for each patient. Rehabilitation may include: physiotherapeutic procedures (electrophoresis, UHF, paraffin therapy, etc.), hand massage, physiotherapy exercises (with a special set of restorative physical exercises), adherence to the diet recommended by the doctor.

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Cost of treatment of a fracture of the humerus

The radius is one of the two bones of the forearm. It consists of a head, a central section – the diaphysis, and a metaepiphysis – the lower end.

A fracture of the radius occurs due to a fall on an outstretched hand or from a blow to the wrist. This is a very common injury: in terms of frequency, it leads among fractures of the bones of the hands. Such injuries are especially common in people involved in full-contact martial arts, skiing, basketball, skateboarding, and cycling. A fracture can also occur against the background of osteoporosis, a disease that increases bone fragility.

A fracture of the radius in a typical location can be extensor (Kolles) or flexion (Smith). As a rule, the larger of the two bones of the forearm, the radius, suffers, but sometimes the styloid process of the ulna is also damaged. The bone breaks at the bottom where it joins the thumb side of the wrist bones.

Fracture symptoms

The classic signs of a fracture include pain, limb deformity, and dysfunction. The pain gets worse when you bend your wrist. Swelling and hematoma may occur at the fracture site. Sometimes there is a rare type of “dinner fork” deformity that makes the wrist look crooked.

Diagnostics

An orthopedic traumatologist will conduct an examination, take several x-rays (images in different projections are needed, because the nature and extent of the injury can not be fully assessed on one). In the case of a complex fracture, CT (computed tomography) may be required. All the necessary examinations can be done at GUTA CLINIC, which is equipped with modern expert-class diagnostic equipment.

Treatment

The fracture can be treated conservatively or surgically. To select treatment tactics, the doctor will evaluate a number of factors: bone displacement, the presence of splinters, nerve damage, etc. Conservative methods (casting) treat simple fractures, but it takes time.

Comminuted or complicated fractures (or simple ones, if the patient wants to save time and not wear a cast) are treated surgically. An operation is also prescribed if the bone does not grow together for a long time.

The surgeon will make an incision on the inside of your wrist (where you can feel your pulse). The doctor will connect the broken bones together with one or two plates and screws. After that, the hand is immobilized. Get ready for frequent x-rays – this is important to determine if the bone heals properly.