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.

To Top

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.

To Top

How To Tell If Your Hand Is Broken — Broken Hand, Finger, And Wrist Symptoms And Treatment: Sports Medicine Oregon: Orthopedic Surgery

How To Tell If Your Hand Is Broken — Broken Hand, Finger, And Wrist Symptoms And Treatment

According to recent estimates published in the Journal of Orthopaedic Surgery and Research, approximately one-quarter of all sports injuries involve the hands or wrists. Hand fractures and broken fingers are currently on the rise due to increased athletic competition around the country, but these kinds of injuries are also common off the playing field, especially for older adults. As part of the natural aging process, our bones weaken over time, leaving us more vulnerable to fractures and other injuries. Regardless of the cause, there are many effective broken hand treatments and strategies to help expedite the recovery process and prevent reinjury. In this post, we will explain many common broken hand symptoms and what to do for a broken hand, including physical therapy and surgical options. Let’s take a look…

Anatomy Of The Hand: Different Types Of Hand Fractures

With 27 bones and 28 muscles, the human hand is certainly nimble, but it is also highly susceptible to injury, especially acute injuries as a result of direct trauma. Along with the ends of the forearm’s radius and ulna, the skeletal structure of the wrist is composed of eight small carpal bones. Beyond these, the palm of the hand is made up of five total metacarpal bones. Each of these is labeled numerically, one through five, with the first metacarpal controlling the thumb. The “neck” of each metacarpal bone is the thinnest part just behind the knuckle, whereas the “base” of each bone is the end situated closest to the wrist. Beyond the metacarpals, each finger has three phalanges, while the thumb has two. One of the most common types of hand fractures, commonly known as Boxer’s Fracture, is a break in the neck of the fifth metacarpal — the one controlling the pinky. As the name suggests, a Boxer’s fracture is often the result of a closed fist striking a hard object, or otherwise sustaining direct trauma during a collision. Fractures to the scaphoid bone (the carpal bone situated just below the thumb) are also common, especially during college football and other athletics.

Broken Hand Symptoms: How Do I Know If I Have A Broken Hand?

Approximately 6 million people suffer a broken bone every year in the United States, and broken fingers are very common. The location and severity of the hand fracture will determine the symptoms the patient experiences and the available treatment options. So what does a broken hand feel like? Let’s take a look at a few of the most common broken hand symptoms.

Fractured hand symptoms involving the metacarpals include pain, swelling, general tenderness along the site of the injury, and bruising. These metacarpal fractures symptoms may be more pronounced as the patient makes a fist or even loosely grips items. Metacarpal fractures may also give the involved fingers a shortened appearance. For example, Boxer’s fracture symptoms may include the knuckle appearing indented or crushed inward due to displacement along the neck of the metacarpal. Broken finger symptoms include pain, decreased range of motion, swelling, and sensitivity to even the lightest touch. Fractured finger symptoms may also include bruising, and it’s possible for the finger to appear deformed or misaligned. Broken thumb symptoms include swelling, bruising, sensitivity to the touch, and decreased range of motion. Some patients also report numbness or feelings of cold around the injury. In some cases, the hand or fingers may change colors, becoming pale or even blue, after a fracture of the hand. Patients may also notice other tactile sensations, such as tingling.

Scaphoid fractures are the most common injuries involving the eight small carpal bones along the base of the wrist. Scaphoid fracture symptoms include pain, swelling, and sensitivity to touch. Pain symptoms may increase as the individual makes a fist or closes the hand. However, just because a person is still capable of making a fist or using the digits with minimal discomfort does not mean he or she has not suffered a broken hand or finger. It’s important to remember that many broken hand symptoms are similar to those of other potential injuries, and diagnosis by a medical professional is key. Prompt medical attention is necessary to prevent further injury and help expedite the recovery process. Accurate diagnosis of the extent of the damage will require a physical examination and potentially the use of diagnostic imaging tests. After these tests, your doctor will recommend appropriate broken hand treatment options.

Hand Fracture Treatments: How To Treat A Broken Hand

There are many broken hand treatment options to address broken fingers, broken metacarpals, and other hand injuries. Fortunately, many hand fractures will not require surgical intervention, although splints, braces, straps, and the classic “buddy system” may be used to immobilize the affected bones. In some instances, patients may need to wear larger casts to immobilize the entire hand or wrist. These splints and casts hold the bones in place, allowing the area to heal, while also minimizing the risk of reinjury during the recovery process. In the event of misalignment, the overseeing medical professional may need to manually reposition the finger before utilizing a splint or cast. These noninvasive treatments are viable for most situations, but in the case of more severe injuries, your doctor may recommend surgical intervention for optimal results and recovery.

Broken Hand Treatment Options: Hand Fracture Surgery

Fractures that cannot be properly corrected with the aforementioned treatment strategies will require broken hand surgery. During hand fracture surgery, local or general anesthesia may be used depending on the specific surgery. Broken hand surgery may involve the use of small pins and wires that will hold the fractured bones in place for several weeks. In some instances, metal plates and screws may be utilized to ensure the bones of the hand are properly aligned. If a bone has been shattered, it may be necessary to use a bone graft transplanted from another part of the patient’s body. A bone graft may also be used to treat a bone that has not healed properly after a previous injury.

The Recovery Process: Broken Hand Healing Time

Most patients should expect to have a follow-up appointment with their doctor within a week or two of the procedure. During the recovery process, the overseeing medical professional may use intermittent imaging tests to make sure the bones are healing properly. Pain and swelling are to be expected after surgery, and your doctor may prescribe medication to help. Over-the-counter pain medications can also be used to treat pain, discomfort, and swelling. To further minimize swelling, it’s important to keep the injury elevated following surgery. Ideally, the hand should be kept higher than the heart, meaning the patient may need to prop it up while seated or lying down. Ice packs may also be used to help with pain and swelling. When using this method, a towel should be kept between the ice packs and the skin, to prevent direct contact and reduce the risk of frostbite. Additional procedures may be required to remove hardware used to hold the bones in place during the healing process.

Broken hand recovery time will be different for every injury and every patient. With proper treatment, broken fingers will typically heal within a few weeks and broken hands within one to two months, although it may take several months to make a complete recovery from a severely broken hand.

Broken Hand Rehab — Broken Hand Physical Therapy Exercises

Physical therapy may be recommended for some hand injuries to help with the recovery process. Finger and hand physical therapy exercises are used to alleviate pain and discomfort related to stiffness and inflammation, and they can also help patients restore strength lost as a result of extended immobilization. The overseeing physical therapist will first gauge a patient’s range of motion and overall functionality before establishing a comprehensive regimen of hand physical therapy exercises. Once the patient has demonstrated proficiency, these broken hand physical therapy exercises should be performed at home daily for optimal results. Hand therapy putty and common everyday household items such as towels and cups may be used to help with strength training exercises. Stretching exercises will also be incorporated to increase the range of motion.

Many hand and finger injuries in the workplace and on the playing field are preventable, and hand and finger injury prevention should be practiced as part of daily operations. Preventing hand injuries in the workplace and on the playing field is often as easy as wearing appropriate gear for the job or sport at hand. For athletes, this means ensuring protective gloves and wrist guards are in good condition and fit appropriately. On the job site, it’s imperative to incorporate the best ergonomic practices and also wear appropriate safety gear, such as approved hand and wrist protection. Stretching before and after activity may also keep muscles, tendons, and ligaments primed for use and minimize other hand and wrist injuries.

At Sports Medicine Oregon, we specialize in the full spectrum of broken hand and broken finger treatment options. While some hand fractures and broken fingers will require surgical intervention, many other hand injuries can be adequately treated using the latest noninvasive therapies. Additionally, individuals who need physical therapy after a broken hand can greatly benefit from comprehensive care at our state-of-the-art physical therapy facility. Whether your broken hand is a sports injury or the result of an accident around the house, our team is dedicated to getting you back to your active lifestyle with a personalized approach to broken hand treatment, rehabilitation, and injury prevention.

Remember, we update our Sports Medicine Oregon blog monthly, so be sure to tune in often to stay up to date on the latest sports medicine news and views!

5 Ways to Make Your Workouts Arthritis-Friendly

Keeping your body moving is what keeps your joints moving, and as luck would have it, it’s also what helps ease inflammation to take the edge off arthritis pain and stiffness — naturally. Here are our top five arthritis-friendly workouts.

Why You Shouldn’t Play Through an Injury

No pain, no gain: It’s a common cliché about presumed rewards of pushing your physical capacity to the max. But should you really “walk it off” and play through the pain when you have a sports injury? Find out here.

Tips for Reducing Swelling In Your Joints

Traumatic injuries, overuse, infection, and arthritis are many potential causes of joint swelling. Find out more about this common problem, and learn a few effective ways to ease it quickly.

Exercises You Can Do At Home to Strengthen Your Ankle

A weak ankle leaves you vulnerable to injury (or reinjury), and can ultimately lead to the kind of chronic joint instability that compromises your mobility. Here are a few simple strengthening exercises you can do at home.

4 Habits That Support Strong, Healthy Hips

Your hips may be the strongest joints in your body, but that doesn’t mean they’re invincible. Here, our expert team offers four invaluable habits that can keep your hips healthy, mobile, and pain-free as you age.

Life After a Knee Injury

Whether you’ve injured your knee on the field or during routine daily activities, taking the right steps can help ensure your post-injury life isn’t hampered by continuing knee pain and limited mobility. Here’s what you should know.

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.

Clinic NCC No. 2 (CCH RAS) offers you to make an appointment with specialized specialists in Moscow.

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.