What are the common causes of hand fractures. How can you recognize the symptoms of a broken hand bone. 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

The human hand is a complex structure composed of multiple small bones that work together to provide dexterity and strength. To better understand hand fractures, it’s essential to familiarize yourself with the basic anatomy of the hand:

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

Hand fractures can occur in any of these bones, but some are more common than others. The most frequent type of hand fracture is a break in the fifth metacarpal, which supports the little finger. This injury is often referred to as a “boxer’s fracture” due to its association with punching.

What causes a boxer’s fracture?

A boxer’s fracture typically results from:

• Punching a hard object with a closed fist
• Falling onto an outstretched hand
• Motor vehicle accidents
• Other traumatic impacts to the hand

Recognizing the Signs and Symptoms of Hand Fractures

Identifying a hand fracture early is crucial for proper treatment and recovery. Here are the common signs and symptoms to watch for:

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

How can you distinguish between a sprain and a fracture?

While sprains and fractures can have similar symptoms, there are a few key differences:

• Fractures often cause more severe pain and swelling
• A visible deformity is more likely with a fracture
• Fractures may produce a snapping or popping sound at the time of injury
• Sprains typically allow for some range of motion, while fractures severely limit movement

If you’re unsure, it’s always best to seek medical attention for a proper diagnosis.

Diagnostic Procedures for Hand Fractures

When you visit a healthcare professional with a suspected hand fracture, they will perform a thorough evaluation to determine the extent and location of the injury. The diagnostic process typically includes:

Physical Examination

During the physical exam, your doctor will:

• Assess the extent of swelling and bruising
• Look for any visible deformities
• Check for overlapping fingers
• Examine the skin for cuts or lacerations
• Test your range of motion
• Evaluate joint stability
• Check for signs of nerve damage, such as numbness in the fingers

X-ray Imaging

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

• Confirm the presence of a fracture
• Determine the exact location of the break
• Assess the severity and type of fracture
• Check for any displacement or angulation of bone fragments

In some cases, multiple X-rays from different angles may be necessary to fully evaluate the injury.

Conservative Treatment Options for Hand Fractures

Many hand fractures can be successfully treated without surgery. The choice of treatment depends on the location, type, and severity of the fracture. Here are some common conservative treatment approaches:

Closed Reduction

If the bone fragments are not properly aligned, your doctor may perform a closed reduction. This procedure involves:

• Manipulating the bone fragments back into proper alignment without making an incision
• Using local anesthesia to minimize discomfort during the procedure
• Confirming the alignment with X-rays after reduction

Immobilization

After reduction (if necessary), the fractured hand will be immobilized to allow proper healing. This may involve:

• Applying a cast that extends from the fingertips to near the elbow
• Using a splint or brace to keep the bones aligned
• “Buddy strapping” the injured finger to an adjacent healthy finger for support

The duration of immobilization typically ranges from 3 to 6 weeks, depending on the fracture’s location and severity.

Follow-up Care

During the healing process, your doctor will likely:

• Order follow-up X-rays at 1-2 weeks to ensure proper bone alignment
• Monitor your progress and adjust treatment as necessary
• Recommend gentle hand exercises after about 3 weeks to prevent stiffness

Surgical Interventions for Complex Hand Fractures

While many hand fractures can be treated conservatively, some cases require surgical intervention. Surgery may be necessary in the following situations:

• Severely displaced or angulated fractures
• Open fractures (where the bone has broken through the skin)
• Fractures involving joints
• Multiple fractures in the hand
• Fractures that fail to heal properly with conservative treatment

What surgical techniques are used for hand fractures?

Depending on the specific case, surgeons may employ various techniques to repair hand fractures:

• Open reduction and internal fixation (ORIF): This involves making an incision to directly access the fractured bone, realigning it, and securing it with pins, plates, or screws.
• External fixation: In some cases, an external frame may be attached to the bones using pins that protrude through the skin. This method is often used for complex or open fractures.
• Bone grafting: For fractures that don’t heal well or have significant bone loss, a bone graft may be necessary to promote healing and restore structure.

What is the recovery process like after hand fracture surgery?

Post-surgical recovery for hand fractures typically involves:

• A period of immobilization with a cast or splint
• Pain management and wound care
• Gradual introduction of hand exercises and physical therapy
• Regular follow-up appointments to monitor healing progress
• Potential removal of hardware (pins, plates) once healing is complete

Rehabilitation and Long-Term Outcomes for Hand Fractures

Proper rehabilitation is crucial for regaining hand function and strength after a fracture. The rehabilitation process may include:

• Gentle range-of-motion exercises to prevent stiffness
• Strengthening exercises to rebuild muscle and improve grip
• Occupational therapy to assist with daily activities and work-related tasks
• Techniques to manage swelling and reduce scar tissue formation

How long does it take to fully recover from a hand fracture?

Recovery time varies depending on the severity of the fracture and the treatment method. Generally:

• Simple fractures may heal in 4-6 weeks
• More complex fractures or those requiring surgery may take 2-3 months or longer for full recovery
• Complete restoration of strength and function can take up to 6 months in some cases

It’s important to follow your doctor’s instructions and attend all follow-up appointments to ensure optimal healing and prevent complications.

Preventing Hand Fractures and Maintaining Hand Health

While not all hand fractures can be prevented, there are steps you can take to reduce your risk and maintain overall hand health:

• Wear appropriate protective gear during sports and high-risk activities
• Use proper technique and form when engaging in activities that put stress on your hands
• Maintain good bone health through a balanced diet rich in calcium and vitamin D
• Perform regular hand exercises to improve strength and flexibility
• Be cautious when walking on slippery or uneven surfaces to prevent falls
• Avoid punching hard objects or surfaces, even in moments of frustration

What exercises can help strengthen hands and prevent injuries?

Consider incorporating these exercises into your routine to maintain hand strength and flexibility:

• Finger flexion and extension exercises
• Wrist rotations and stretches
• Grip strengthening with stress balls or hand grippers
• Thumb opposition exercises
• Finger spreading and adduction movements

Always consult with a healthcare professional before starting any new exercise regimen, especially if you have a history of hand injuries or conditions.

When to Seek Medical Attention for Hand Injuries

Knowing when to seek medical care for a hand injury is crucial for proper diagnosis and treatment. You should consult a healthcare professional if you experience:

• Severe pain or swelling that doesn’t improve with home care
• Visible deformity of the hand or fingers
• Inability to move your fingers or make a fist
• Numbness or tingling in the fingers
• Changes in skin color or temperature of the affected area
• Any open wounds or cuts associated with the injury

What first aid measures should be taken for a suspected hand fracture?

While waiting to receive medical attention, you can take the following steps:

• Apply ice to the injured area to reduce swelling and pain
• Elevate the hand above heart level to minimize swelling
• Avoid moving or attempting to straighten the injured fingers
• Cover any open wounds with a clean, sterile dressing
• Take over-the-counter pain medication if needed, following package instructions

Remember, these measures are temporary and do not replace professional medical care. A proper diagnosis and treatment plan are essential for optimal recovery from hand fractures.

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

Hand Fractures | Common Hand Injury

Introduction

Fractures of the hand are common injuries. A fracture implies a break of any of the bones of the hand. Typically, fractures are associated with trauma—a fall, motor vehicle accident, bicycle mishap or sporting event.

Due to the presence of multiple joints, hand fractures require skilled care. Fortunately, most hand fractures can heal without surgery. However, even fractures managed without surgery may require extensive bracing and therapy due to stiffness and swelling these injuries cause.

Anatomy

The hand is the terminal functional unit of the arm. It is connected to the arm via the forearm (radius and ulna) and the eight bones of the carpus the hand is composed of both metacarpal and phalangeal bones. These bones are the foundation for function of the four fingers and thumb.

Bones of the hand and wrist from a front and bottom view.

Diagnosis

Symptoms

Almost all hand fractures occur as a course of trauma—the vast majority are due to falls on an ourstretched arm. Patients tyically report pain, swelling, deformity, and bruising of the hand. Inhibition of finger and wrist motion are also common complaints.

X-ray of a displaced fracture of the shaft of the 5^th metacarpal bone.

Hand Surgeon Examination

Physical Examination

Your hand surgeon will review your symptoms and inquire as to any pertinent family or medical history. At this point an examination of the injured limb is undertaken. Inquiries are usually directed to ascertain the presence of other ipsilateral injuries either to the wrist, forearm, elbow or shoulder.

An examination of the extremity is then focused on a neurological exam—both sensory and nerve motor function. Also the vascular status of the hand and digits are reviewed to insure swelling has not embarrassed the vascular supply. Areas of tenderness to palpation may indicate potential fracture, contusion or sprain. Skin integrity over areas with suspected fracture are noted—as these areas may indicated an open fracture.

Range of motion of joints is reviewed—both potentially as passive and active range of motion. In fractures of the hand, motion can uncover alignment issues including splaying or scissoring of digits. For hand injuries, with the fingers flexed the nails typically point toward the scaphoid bone of the wrist. Abnormal rotation is again accentuated and better appreciated with range of motion of the hand.

Imaging

Plain x-rays are the workhorse of evaluation for hand fractures. Multiple angles may be necessary to uncover and appreciate fractures. Some hand and wrist fractures may not be discernable on initial x-rays. If there is suspicion of fracture, often the extremity is splinted and the patient recalled in 1-2 weeks for additional x-rays.

X-ray of a displaced fracture of the shaft of the 5^th metacarpal bone.

Advance imaging such as CT or MRI is sometimes useful. CT offers the advantage of viewing complicated fractures from multiple viewpoints. Modern CT also offers the opportunity to do 3D reconstructions of injuries to provide enhanced viewing.

A 3 D CT scan showing displaced fractures of the base of the index, long and ring metacarpals.

MRI is best suited to add additional information regarding soft tissues injury associated with fracture. MRI offers the ability to image tendon, ligament and muscle.

Treatment

Nonoperative

The vast majority of hand fractures will respond to nonoperative management. Immobilization is typically the first step and the utilization of splints, casts or braces form the initial algorithm for treatment.

Immobilization is typically coupled with elevation to decrease swelling. Immobilization for hand injuries is specific for the injured area. Many times the immobilized position is termed an “intrinsic plus” position—in that the proximal finger joint is flexed 90 degrees while the distal joints are held in extension. Changes in immobilization as the fracture heals is typical and patients may progress through a variety of splints, casts, and braces.

Range of motion of an effected joints or areas prevents stiffness from becoming an issue in areas without fracture. Also the braces utilized for fracture typically becomes shorter as healing progresses. Involvement with hand therapy is typical for many hand fractures. A hand therapist can guide the balance between immobilization necessary for fracture heading—and motion necessary to limit joint stiffness.

Operative

Hand fractures with displacement or rotation may require surgical treatment. Surgery is aimed at restoring alignment and maintaining this alignment. Maintenance of alignment typically requires the placement of hardware into the hand.

Most hand fracture surgery can be completed as an outpatient surgery and the majority done under regional anesthesia. Hardware associated with fractures typically involves either pins (Kirschner wires) or specialized plates and screws. Because the bones of the hand are smaller, proportionately smaller pins and screws are necessary for fixation. Because of the specialized structure of the hand, hardware removal may be necessary.

A fracture of the ring metacarpal treated with plates and screws

WATCH AN ANIMATED SURGICAL VIDEO OF TREATING HAND FRACTURES

For most patients, blood loss is minimal and unless there are medical indications—prophylaxis for deep vein thrombosis is not necessary. Other risks of surgery are small and include infection, bone healing, tendon rupture, and stiffness.

Patients are placed into a splint after surgery and typically return in two weeks for suture removal. Patients who receive regional anesthesia report less pain after surgery, but all patients should follow instructions regarding pain medications to improve their postoperative experience. Once patients recover from the surgical pain of application of the hardware, most report considerable improvement in their overall hand discomfort.

Rehabilitation

After surgery patients are instructed in elevation of the extremity and work on range of motion for the digits not affected. At two weeks most patients have suture removal and some are placed into a removable brace… By six weeks after surgery, most patients will have considerable healing of the fracture will likely start weaning from the splint. Work on range of motion can be accomplished at home or with the help of a hand surgeon. Strengthening of the hand, wrist, and arm are emphasized and most patients should gain good use of their wrist and hand—especially with diligent work on motion and strength.

Outcomes

Modern fracture care has greatly improved the results for patients. However, patients can still expect some degree of stiffness with any fracture care and at times additional surgery may be warranted. Return to sports after injury typically requires 3-6 months. Patients report continuing improvement for up to one year after injury.

Hand fracture – signs, first aid, treatment in Moscow

Hand fractures are diagnosed in 30% of patients who visit a traumatologist. The prevalence of injury is explained by the fact that when there is a threat of a fall, a person automatically puts his hands in front of him, which leads to severe injuries. A fracture of the bones of the hand has a pronounced clinical picture, but an x-ray is necessary to clarify the diagnosis.

What bones does the hand consist of

The hand consists of 27 small bones, which are rather fragile and easily injured.

Groups of bones:

• wrists;
• metacarpals;
• finger phalanges.

In the wrist there are 8 short bones with a spongy structure, which are arranged in two rows. The upper row goes from the little finger to the thumb, consists of the pisiform, trihedral, lunate and scaphoid bones. All bones, except for the pisiform, join the radius – this is the wrist joint.

The structure of the lower row includes the hamate, capitate, trapezius and polygonal bones. They are connected to the tubular metacarpal bones, which are attached to the bones of the phalanges of the fingers.

Why do the bones of the hand break?

Fracture of the hand – an open or closed injury, in which there is complete or partial damage to the bone components. Most often it is associated with an external mechanical effect on the hand. This may be a fall of a load, a blow with a heavy object, a fall with an emphasis on the brush, a palm being squeezed between hard surfaces.

In the elderly, hand bone damage occurs more frequently as bone density decreases with age. The risk of fracture, even with a slight bruise, increases with a history of osteoporosis, hormonal disorders, if a person takes diuretics uncontrollably.

Types of fractures of the hand

In traumatology, fractures of the hand are classified according to several criteria. Given the violation of the integrity of the skin, fractures are open and closed. There are traumatic fractures, which are obtained as a result of a fall or blow, and pathological fractures, in which damage to bone structures occurs in elderly people without a cause or after a weak impact.

Types of fractures according to the nature of damage:

• simple – bone destruction without fragments occurs in one place;
• fragmentary – in case of injury, two fault lines are formed, between the fragments there is a fragment of the whole bone tissue;
• comminuted – the bone is crushed into many small fragments;
• crushed – the most severe type of injury, in which the anatomical shape of some parts of the bone formation is disturbed.

The severity of a fracture of the hand is determined by the direction of the fracture line and the presence of displacement of bone fragments. Displaced fractures take longer to heal than uncomplicated injuries.

Types of fractures according to the type of damage:

• complete – the bone breaks in one or more places;
• incomplete – cracks form on the bone;
• by type of branch – this injury is often diagnosed in children, destruction of bone structures does not affect the periosteum.

If the middle of the bone is destroyed, such a fracture is called diaphyseal, if the head of the bone is injured – epiphyseal. When the bones are fractured inside the joint, a Bennett or Rolando fracture is diagnosed, this is an intra-articular injury. If the fracture line does not involve the articulation, it is an extra-articular fracture.

Types of fractures by location

There are three groups of hand fractures: carpal bones, metacarpal bones and phalanges of fingers.

Fractures of the bones of the wrist are rarely diagnosed, most often the scaphoid bone is affected, which breaks into two parts. Often the fracture is aggravated by dislocation. False joints, cysts inside the bone are often formed at the site of the fracture. The duration of immobilization is 1-6 months.

Metacarpal fractures are the most common type of injury. Its varieties:

1. Fracture of the 1st metacarpal bone occurs when a hard object is struck with a bent thumb.
2. Intra-articular or extra-articular fracture of the base of the first metacarpal. Bennett’s fracture is characterized by displacement of the injured bone towards the radius, while the triangular fragment is not displaced, since it is held by ligaments. Roland’s fracture – dislocation of the metacarpal bone fragment to the radius with simultaneous fracture of the first metacarpal bone into several fragments.
3. Fracture of the medial portion of the first metacarpal. They are rarely detected after a direct blow to the bone.
4. Fractures II, III, IV, V of the metacarpal bones – a consequence of falling on a fist or hitting a hard surface with a fist. Most often, there is damage to several bone structures at once, most often the fourth and fifth.
5. Fractures of the phalanges of the fingers are a common injury. Types – helical, comminuted, transverse, intra-articular, extra-articular.

How to recognize a wrist fracture?

If the integrity of one or more bones of the hand is broken, characteristic general and specific symptoms appear.

The main manifestations of a fracture of the hand:

• severe pain in the damaged area – there are many nerve endings and pain receptors in the palms and fingers;
• extensive edema – extends not only to the hand, but also to the wrist joint, forearm;
• subcutaneous hemorrhage – hematoma may be small or cover a large area;
• the skin over the injured bone becomes bluish, hot to the touch;
• impaired mobility of the hand – even a slight movement leads to an increase in pain;
• part of the hand or fingers are deformed, bone fragments can be seen under the skin;
• for open fractures, the presence of wounds in which damaged bone and muscle tissues are visible is characteristic.

If the wrist area is damaged, the victim cannot clench his hand into a fist. With any movement, severe pain occurs, which radiates to the navicular bone, phalanxes of the 3rd and 4th fingers. With the destruction of the bones at the base of the finger, a pronounced pain syndrome occurs when you try to move your index finger. At the same time, the thumb is located unnaturally – in a bent form, it is pressed against the hand. If the integrity of the bones of the fingers is violated, deformation, deviation along the vertical axis of the phalanges is observed.

If bone fragments are displaced, a hard formation appears under the skin. On palpation, pain occurs, the formation is easily shifted, and a crunch is clearly heard when parts of the bones are rubbed against each other.

Fractures of the hand are often accompanied by complications. When the nerves are ruptured, a person cannot control the hand, since the signals from the brain do not reach the muscles and ligaments, the sensitivity of the hand decreases or completely disappears. With a rupture of the tendons, sensitivity is not disturbed, but it is difficult for the victim to perform many movements.

Diagnostic measures

If a wrist fracture is suspected, a traumatologist should be consulted. The doctor makes the initial diagnosis based on the collection of anamnesis, analysis of the patient’s complaints and external examination. To exclude dislocations or severe bruising, an x-ray is prescribed in two or three projections.

In some cases, X-rays cannot be taken immediately due to severe swelling of the soft tissues. In such cases, the examination is carried out after 8-10 days. At this time, the injured arm is fixed with a rigid plaster cast or polymer bandages.

Methods of treatment

When the bones of the hand are fractured, it is necessary to fully restore the functions of the injured limb. To do this, bone fragments are compared, plaster is applied, then rehabilitation is required. Reposition of the bones is carried out under local, rarely general, anesthesia.

A plaster cast is applied from the head of the metacarpal bones to the upper third of the forearm. The thumb is fixed to the bandage. After 2-3 weeks, a second x-ray is taken.

Incorrect casting may cause long-term effects. If the bandage is applied too tight, it compresses the tissues, the vessels are pinched. Within a few weeks of immobilization, due to circulatory disorders, the articulation atrophies, and ischemic contracture develops.

If the cast or splint is loose, the patient makes involuntary hand movements. This leads to displacement, improper fusion of the bones, and the anatomy of the hand is disturbed.

Osteomyelitis can become a complication of an open fracture of the hand. The disease develops when bacteria from the external environment penetrate the bone tissue, which causes a cavity with pus to form. Signs – severe, constant pain, fever, symptoms of severe intoxication. Bone density decreases, which often causes a second fracture at the site of the previous one.

Non-steroidal anti-inflammatory drugs are prescribed to eliminate the pain syndrome, if they do not help – glucocorticosteroids. To speed up the process of bone tissue regeneration, it is necessary to take chondroprotectors, calcium preparations.

When is surgery required for a broken hand?

If complications are identified, surgery is required. There are several types of interventions:

1. Osteosynthesis. During the operation, the edges of the destroyed bone are fastened with staples or metal pins. Then a plaster bandage is applied.
2. Bone grafting. The whole bone tissue of the patient or donor, or an artificial implant, is placed in the injured area. This allows you to speed up the process of repairing damaged bones.
3. Arthrodesis. The operation is performed with multiple comminuted fractures of the hand. The bones are immovably fixed in the desired position with the help of artificial fixators, the joint does not move.
4. Endoprosthetics – damaged bone structures are replaced with artificial implants.

The doctor selects the method of surgical intervention individually for each patient. This takes into account the age and general condition of the patient, the nature of the damage, the presence of contraindications.

Rehabilitation period

The recovery period begins after the removal of the cast. To restore blood circulation in the hand and fingers, joint mobility, eliminate muscle atrophy, massage, physiotherapy and physiotherapy exercises are prescribed.

Massage improves muscle function and hemodynamics. Passive influence promotes the development of joints, improves joint mobility.

A set of therapeutic exercises is selected by a doctor, taking into account the type and severity of a fracture of the hand. The first sessions of exercise therapy should be performed under the supervision of a specialist, then you can do it yourself at home.

A few simple exercises to restore hand mobility:

1. Slowly open and close your fist.
2. Connect the thumb alternately with the rest of the fingers.
3. Connect all fingers except the little finger, it must be taken to the side.
4. With a little effort, interlace the fingers on both hands.
5. Useful for tying shoelaces, assembling diamond mosaics or matchstick figures.

You need to start with 3-5 repetitions, gradually increase the load. If severe pain, swelling or redness occurs, stop exercising and consult your doctor. After full recovery of the mobility of the hand, you can perform weight-bearing exercises to develop muscle strength.

Physiotherapy is prescribed to speed up recovery. Additionally, a course of treatment should be taken every 6 months to maintain the therapeutic effect.

To restore the mobility of the hand after a fracture, the following physiotherapy is prescribed:

• magnetotherapy;
• electrophoresis;
• laser therapy;
• ultrasound treatment;
• applications with paraffin, ozocerite.

With timely access to a traumatologist, following all the doctor’s recommendations, damaged bones of the hand are restored completely without negative consequences.

The duration of the rehabilitation period is 3–8 months. All this time, the patient must wear a fixing bandage.

To reduce the risk of injury to the hand, it is necessary to follow the safety rules in the workplace, wear comfortable shoes to avoid falls. During outdoor activities, sports, do not forget about protective devices. To prevent bone fragility, it is necessary to eat right, lead a healthy lifestyle, and take vitamin complexes.

Q&A

What is the difference between sprain and wrist fracture?

When sprained, the ligaments are stretched, partially or completely torn, but the integrity of the bone structures is not disturbed. When the ligaments are torn, the pain is sharp, but short-lived. After a while, it reappears due to the development of the inflammatory process inside the tissues. With a fracture, the pain is weak, but constant, aching, not pulsating. When stretching I, II degree, the mobility of the wrist is practically not disturbed, but any movement is accompanied by pain. With a fracture, it is impossible to move the brush. Applying cold to the sprain helps relieve pain for a long time. With fractures, this procedure gives a short-term effect.

What are the first aid rules for suspected wrist fracture?

Correct first aid helps to avoid complications after an injury. First, the injured hand should be examined, if possible, remove all jewelry, apply a cold compress for 10-15 minutes. If there are wounds, they must be carefully cleaned, treated with peroxide, covered with a sterile bandage. If fragments are visible, they cannot be set on their own. The injured hand must be immobilized – bandage the hand to the body without affecting the area of ​​\u200b\u200bthe hand. With severe pain, painkillers can be given, but it is better to refrain from taking medication so as not to blur the clinical picture. After providing first aid, take the victim to the emergency room.

How long should a cast be worn?

The duration of immobilization depends on the number of broken bones, the complexity of the fracture. For uncomplicated fractures, a cast should be worn for 2-3 weeks. In severe injuries, after surgery – 2-6 months.

Peculiarities of fracture in children | clinic blog Nashe Vremya

Statistics vary from country to country: for example, according to some reports, the risk of such an injury in childhood is 42–64% for boys, and 27–40% for girls.

Small children often fall, hit, drop various objects, sometimes heavy ones, on themselves. But this does not always lead to bone fractures. Some features of the child’s body provide protection:

• Large volume of soft tissues in relation to body size, which act as an airbag.
• More elastic bone tissue due to low content of mineral salts and high water content.
• Thick and well-perfused periosteum – it creates a secure sheath. Due to it, the bone grows in width.

Another factor is due to some features of fractures in children. In long tubular bones, the following main parts are distinguished:

• Diaphysis – the body of the bone, its central part in the form of a round or trihedral tube.
• Epiphyses – the ends on which the articular surfaces are located.
• Apophyses are protrusions that are outside the joints. They have a rough surface, ligaments and muscles are attached to them.
• Metaphyses are located between the diaphyses and epiphyses.

In children, between the epiphyses (apophyses) and the metaphysis, there is a growth zone (cartilaginous tissue with dividing cells), due to which the bone grows in length, and these are weak points.

Therefore, in children, fractures occur so often just in the growth zone, which clinically (outwardly) can be mistaken for a dislocation.

Features

Some specific types of fractures occur in childhood:

• Green line . The bone is bent, and a fracture appears only on its convex part, that is, on the one hand, the periosteum and cortical layer are torn, and on the other hand, the bone remains intact. It can happen to any long bone, but the forearm is most commonly affected. You can imagine this well by trying to break a growing green branch near a tree in the spring.
• Subperiosteal fracture . The bone breaks, but the periosteum (bone case) that covers it remains intact. At the same time, the periosteum fixes the fragments and prevents a strong angular displacement.
• Epiphysiolysis – trauma accompanied by a detachment of the epiphysis along the line of the growth zone. It shifts in relation to the metaphysis.
• Osteoepiphyseolysis or metaepiphysiolysis . Together with the epiphysis, a piece of the metaphysis comes off – usually a triangular shape. Types of fractures of the growth zone are described in detail in the Salter-Harris classification. Most often, 5 types are distinguished. This is important in pediatric traumatology, since the type of fracture determines how likely the growth plate is to stop. If the growth zone is damaged, then limb deformity may occur in the future.
• Apophysiolysis – avulsive fracture (when the apophysis is torn off). Since ligaments and muscles are attached to the apophysis, a fracture (separation) occurs under the action of the force of contraction.
• Depressed skull fractures (celluloid ball type). Such fractures can occur in young children, as their bones are plastic. Damage looks like a dent in a table tennis ball.

Types of fractures

The main classifications and types of fractures in children are presented in the table:

Causes of fractures

The immediate cause of a fracture is trauma, when the bones are not strong enough to withstand the force acting on them. The mechanisms of traumatic effects are different, the nature of the fracture depends on this.

Several factors make children’s bones more vulnerable to damage:

• Genetic, endocrine and systemic diseases affecting bone metabolism. Such children need to periodically visit a doctor, measure bone density – densitometry. If necessary, the doctor will prescribe drugs to restore the normal state of the bones.
• Low calcium intake as a result of inadequate, insufficient, unbalanced nutrition.
• Frequent use of soda.
• High body mass index (BMI), obesity.
• Sedentary lifestyle.
• Taking certain medications, such as glucocorticosteroids.
• Behavior problems. Injuries are most often received by the most restless children.

Fracture symptoms

The following symptoms of a fracture in children help to roughly judge the nature of the injury:

• Severe pain that comes on suddenly after an injury. If you touch the damaged area, then the pain is greatly increased.
• Marked deformity of the injured limb.
• Edema and hematoma (hemorrhage) at the site of injury.
• Limited mobility or complete inability to move a limb.
• With open fractures, there is a wound in which bone fragments are visible.
• Numbness and tingling in an injured arm or leg may indicate that a broken bone has damaged a nerve.
• In some types of bone displacement, the injured limb becomes somewhat shorter than the healthy one.
• When trying to move the injured limb , a crunch is felt.

How to distinguish a fracture from a bruise?

Soft tissue and bone bruises are less serious injuries than fractures, but their symptoms are often very similar. A bruise can also manifest itself in the form of severe pain, swelling, hemorrhage, and restriction of movement. Do not guess, it is better to take the child to the emergency room as soon as possible – there the doctor will examine him, take pictures and establish an accurate diagnosis.

First aid for fractures

In such situations, adults need to behave calmly and try to calm the child. In case of injuries of the arms and legs, it is necessary to fix the broken bone and two joints above and below the fracture site. For this, any improvised means are suitable: planks, thick cardboard, scarves, rollers, etc. If there is a suspicion of a fracture of the spine, then the child cannot be lifted, turned over and carried on his own – this can lead to displacement of fragments of the vertebrae and damage to the spinal cord. If a fracture of the pelvic bones is suspected, it is also not recommended to move the victim, you need to lay him on his back, bend his legs and put a roller under them.

It is necessary to deliver the child as soon as possible to the emergency room or clinic, where there is a department of pediatric traumatology. If the injury is serious, you should immediately call the ambulance team. For minor injuries, the hospital can be reached by private or public transport.

Open fractures are often accompanied by bleeding – it must be stopped:

• With arterial bleeding, the blood flows out at a higher pressure, in the form of a bright scarlet pulsating jet. In such cases, you need to apply a tourniquet above the wound (but not on bare skin) and be sure to attach a note indicating the time of its application.
• With venous bleeding, dark blood flows out in a constant stream. Most often, in such cases, a pressure bandage is applied, and if it does not help, a tourniquet is used.

With severe pain, you can give the child ibuprofen, paracetamol or nimulide in the usual dosage for his age (this must be reported to the doctor). However, if you see that there is a deformity of the limb, an open fracture accompanied by bleeding, then you need to urgently call an ambulance team and not give food and drink. Injuries of this nature most often need to be operated on under anesthesia, and anesthesiologists are reluctant to take “fed” children under anesthesia. After all, this threatens with aspiration: the contents of the stomach can enter the respiratory tract with all the ensuing consequences.

Independent attempts to set the fragments are strictly prohibited. An injured hand cannot be twisted, turned, pulled. Inaccurate movements can lead to damage to nerves, blood vessels and displacement of fragments.

Diagnostic methods

A simple, fast and informative method for diagnosing bone fractures in children is radiography. Modern digital devices allow you to take clear pictures with minimal radiation exposure. In difficult cases, resort to the help of computed tomography. Sometimes magnetic resonance imaging is used, for example, if it is necessary to assess the degree of compression of soft tissues by fragments, to identify damage to blood vessels and nerves. CT and MRI are also used to diagnose fractures in infants.

Methods of treatment

The traumatologist chooses the appropriate method for treating fractures in children, depending on the damaged bone, the type of injury, the presence and nature of the displacement of fragments, the age of the child, and other factors. In most cases, conservative treatment is indicated – without surgical intervention.

• Immobilization involves fixing the damaged bone with a splint made of gypsum or polyurethane (plastic gypsum). Fixation, depending on which bone is broken and the age of the child, can last from one week to a month or longer. X-rays are taken periodically to assess the position of the fragments and consolidation (the process of bone healing).
• Closed reposition is performed when the fragments are displaced under anesthesia. The doctor compares the fragments without an incision, applying pressure with his hands through the skin.
• Open reposition is indicated when fragments cannot be repositioned in a closed manner, most often due to soft tissue interposition (compression between fragments).
• Skeletal traction . A needle is passed through the bone, a bracket with a tied rope is attached to it, and a load is hung at the other end. For example, this technique is used for fractures of the femur, because the fragments are displaced due to the great strength of the thigh muscles. Currently, this type of fixation is most often used as a temporary fixation, before the final stage of surgical treatment, in order to stretch the fragments.
• External Fixation Rod . It can be used as a temporary solution, for example, for severe open injuries. And if it was possible to carry out an adequate reposition in it and achieve a good position of the fragments, then such an apparatus can be used as the final method of fixation.
• Ilizarov apparatus . It has not lost its relevance even today. Almost all types of fractures can be treated with it. But it is not very convenient for children, and we resort to its help only in severe cases, when it is impossible to apply other types of osteosynthesis. He especially helps out in the treatment of false joints – when fragments do not fully grow together, and mobility occurs between them.
• Osteosynthesis – fastening of bone fragments with metal structures. Now in children’s practice, not only metal structures (steel and titanium), but also biodegradable implants (self-absorbable) have appeared. By itself, osteosynthesis involves fastening the bone with some kind of fixator. In this case, the reposition can be both open and closed. If the fragments cannot be kept in the correct position after manual reposition, then fixation with knitting needles is necessary (most often). Since the growth zones are open in children, we use in traumatology precisely the spokes that do not injure the growth zone (this has been proven in studies), even if they pass through it. It is impossible to compare the fragments and conduct the spokes without the help of an x-ray. With it, we can fully control the quality of the reposition and the position of the spokes in real time. Also in childhood, screws, elastic rods, locking pins, and plates are used as fixators.

Summing up, we can repeat that the choice of treatment methods depends on the nature, type of fracture and the age of the patient. Doctors at the Nashe Vremya clinic have the most up-to-date methods, and they choose among them the best ones for each specific case after a thorough examination of the patient.

Recovery prognosis and recovery period

Usually the prognosis is favorable – fractures in children heal successfully and impaired functions are fully restored. The completeness and terms of recovery depend on the nature of the injury, the presence of damage to blood vessels, nerves, growth zones in the bones, and other factors. The rehabilitation period can last from 1.5 months to a year or more, during which the following activities are carried out at different times:

• exercise therapy, water gymnastics
• massage
• mechanotherapy, occupational therapy
• taking vitamin and mineral complexes that improve the condition of bone tissue

Complications

Serious injuries, untimely and improper treatment can lead to some consequences of fractures in children:

• damage to blood vessels and nerves resulting in impaired movement, limb function
• contracture – restriction of mobility in the adjacent joint
• ankylosis – complete loss of movement
• deformity, shortening of the limb as a result of improper union of fragments
• non-union of fragments and formation of a false joint
• dysplasia of the bone with damage to the growth zones
• purulent-infectious complications are manifested in the form of fever during a fracture in a child, severe pain, swelling, redness of the skin at the site of injury.

Prophylaxis

Parents should teach their child to follow basic safety measures, to avoid situations in which you can get injured, especially on the street, while playing sports. Small children need to be looked after, a safe environment should be created at home and in the yard (if the family lives in a private house). Of course, it will not be possible to follow absolutely everywhere and foresee every situation – security measures are needed within reasonable limits.

In most cases, the prognosis for fractures in children is favorable. They are successfully treated, the bones in the child’s body quickly grow together. However, in order to avoid complications, it is important to carry out the correct treatment as early as possible. Pediatric traumatologists at the Nashe Vremya clinic are always ready to help.

Sources:

1. Savchenko I.V., Avtomonova T.S., Martinen M.S. Features of traumatic injuries in children and factors that determine them // Journal of Medicine: theory and practice, 2021, p.