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.