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 Fractures

Hand fractures are breaks in one or more of the bones that make up the hand structure. To comprehend these injuries better, it’s crucial to understand the basic anatomy of the hand.

The hand consists of two main types of bones:

• Phalanges: These are the small bones that form the fingers and thumb. The thumb has two phalanges, while each finger has three.
• Metacarpals: These are the five longer bones located in the palm of the hand, connecting the fingers to the wrist.

Among hand fractures, the most common is a fracture of the fifth metacarpal, often referred to as a “boxer’s fracture.” This injury typically affects the “neck” of the bone near the knuckle joint and is frequently caused by punching or striking a hard object with a closed fist.

Causes and Mechanisms of Hand Fractures

Hand fractures can occur due to various reasons, including:

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

The specific mechanism of injury often determines the type and severity of the fracture. For instance, a fall on an outstretched hand might result in different fracture patterns compared to a direct blow to the hand.

Recognizing the Signs and Symptoms of a Hand Fracture

Identifying a hand fracture early is crucial for proper treatment and recovery. Common signs and symptoms include:

• Swelling and bruising around the affected area
• Pain and tenderness, especially when touching or moving the hand
• Visible deformity of the hand or fingers
• Difficulty or inability to move the affected finger
• A shortened appearance of the injured finger
• “Scissoring” of fingers (injured finger crossing over its neighbor when making a fist)
• A sunken or depressed knuckle (particularly in boxer’s fractures)

Can you diagnose a hand fracture at home? While these symptoms strongly suggest a fracture, a proper medical evaluation, including X-rays, is necessary for an accurate diagnosis.

Diagnostic Procedures for Hand Fractures

When a hand fracture is suspected, healthcare professionals employ various diagnostic methods to confirm the injury and assess its severity:

Physical Examination

During a physical exam, the doctor will:

• Inspect the hand for visible signs of injury
• Check for swelling, bruising, and deformities
• Assess the range of motion in the fingers and hand
• Evaluate joint stability
• Test for proper tendon function
• Check for any signs of nerve damage, such as numbness in the fingers

X-ray Imaging

X-rays are the primary imaging tool for diagnosing hand fractures. They provide clear images of bone structures, allowing doctors to:

• Confirm the presence of a fracture
• Determine the exact location and extent of the break
• Assess if the bone fragments are properly aligned
• Identify any joint involvement

In some cases, multiple X-ray views may be necessary to fully understand the fracture pattern.

Conservative Treatment Options for Hand Fractures

Many hand fractures can be effectively treated without surgery. The choice of treatment depends on the fracture’s location, severity, and alignment. Common nonsurgical approaches include:

Closed Reduction

If the fracture is not properly aligned, the doctor may perform a closed reduction. This procedure involves:

• Manipulating the bone fragments back into proper alignment without making an incision
• Typically performed under local anesthesia
• Often followed by immobilization with a cast or splint

Immobilization

Immobilization is crucial for allowing the fractured bones to heal properly. Methods include:

• Casting: A rigid cast may be applied from the fingertips to near the elbow, depending on the fracture’s location and stability.
• Splinting: Some fractures can be treated with removable splints, offering more flexibility in certain cases.
• Buddy taping: For some finger fractures, the injured finger may be taped to an adjacent uninjured finger for support.

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

Surgical Interventions for Complex Hand Fractures

While many hand fractures can be treated conservatively, some cases require surgical intervention. Surgery may be necessary when:

• The fracture is severely displaced or unstable
• There are multiple fractures
• The fracture extends into a joint
• Soft tissue injuries accompany the fracture
• Conservative treatment has failed to achieve proper alignment

Surgical options for hand fractures may include:

Open Reduction and Internal Fixation (ORIF)

This procedure involves:

• Making an incision to directly access the fractured bone
• Realigning the bone fragments
• Securing the bones with hardware such as pins, plates, or screws

External Fixation

In some complex cases, external fixation may be used, which involves:

• Placing pins or wires into the bone through small incisions
• Connecting these pins to an external frame for stability
• Allowing for adjustments during the healing process

What factors determine the need for surgery? The decision to operate depends on the fracture’s characteristics, the patient’s overall health, and their functional requirements.

Rehabilitation and Recovery After Hand Fracture Treatment

Proper rehabilitation is crucial for regaining hand function after a fracture. The recovery process typically involves:

Early Mobilization

Gentle hand exercises often begin around 3 weeks after the injury, depending on the fracture’s stability and the treating physician’s recommendations. These exercises aim to:

• Prevent stiffness
• Improve range of motion
• Reduce swelling

Progressive Strengthening

As healing progresses, strengthening exercises are introduced to:

• Rebuild muscle strength
• Improve grip and pinch strength
• Enhance overall hand function

Occupational Therapy

Some patients may benefit from occupational therapy to:

• Relearn daily activities
• Adapt to any limitations
• Improve fine motor skills

How long does full recovery take? The timeline varies depending on the fracture’s severity and the individual’s healing capacity, but complete recovery can take several months.

Potential Complications and Long-Term Outlook

While most hand fractures heal well with proper treatment, complications can occur. Potential issues include:

• Stiffness or reduced range of motion
• Malunion (improper healing of the bone)
• Arthritis, especially if the fracture involved a joint
• Tendon adhesions
• Nerve or blood vessel damage

The long-term outlook for hand fractures is generally positive, especially with appropriate treatment and rehabilitation. However, some factors can influence the prognosis:

• Age of the patient
• Overall health and bone quality
• Severity and location of the fracture
• Adherence to treatment and rehabilitation protocols

Can hand function be fully restored after a fracture? In many cases, patients can regain full or near-full function of their hand with proper treatment and dedicated rehabilitation. However, some complex fractures may result in permanent limitations.

Preventing Hand Fractures: Tips and Precautions

While not all hand fractures can be prevented, certain precautions can reduce the risk:

• Use proper protective equipment during sports and high-risk activities
• Practice fall prevention techniques, especially for older adults
• Avoid punching hard objects or surfaces
• Maintain good bone health through proper nutrition and exercise
• Be cautious when using power tools or machinery

What role does bone health play in preventing fractures? Strong, healthy bones are more resistant to fractures. Ensuring adequate calcium and vitamin D intake, along with regular weight-bearing exercises, can help maintain bone strength.

Understanding hand fractures, their causes, symptoms, and treatment options is crucial for anyone who experiences or is at risk of these injuries. While many hand fractures can be effectively treated with conservative methods, proper medical evaluation is essential to determine the best course of action. With appropriate care and rehabilitation, most patients can expect a good recovery and return to normal hand function.

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.