Definition & Overview

The hand has at least 27 bones and is one of the most used and sometimes abused parts of the body, which makes it prone to a variety of injuries, including fractures. Hand fractures occur when severe force is placed on the hand, breaking a bone. With so many bones in the hand, it’s possible that more than one bone would be fractured at the same time.

However, not all forces will result in a bone fracture. There is a possibility that a bone may be dislocated instead of broken. The symptoms of a dislocation are similar to those of a fracture.

A broken bone will result in pain, swelling, and even decreased function on the affected part. Fractures vary in severity. If the fracture leaves the bone aligned and stable, it’s referred to as a simple fracture. However, extreme forces may break the bone into fragments, which result in the displacement or shift of a fragment, resulting in an unstable fracture. If the bone is shattered into dozens of pieces, it’s called a comminuted fracture.

If the fracture results in the bone breaking the skin, it’s called a compound fracture. Compound fractures have a higher risk of infections, especially if the wound is not treated immediately or soon after the fracture occurred.

Cause of Condition

A hand fracture is a result of excessive force on the hand. Such force can be caused by a sharp or blunt instrument, or if a person falls and supports the weight of the body with a hand. In such cases, the hand and the wrist are at risk of developing a fracture.

Key Symptoms

A hand fracture is usually excruciatingly painful, much more so if the bone pierces through the skin. The area of the fracture will almost immediately begin to swell. If the fracture is severe, it may cause deformation, like a crooked finger.

The hand will also experience some loss of movement. This could continue long after the fracture has healed, mostly because the ligaments and tendons will also be affected. If a fracture affects a joint, it is possible for that joint to develop arthritis.

It’s important to recognize the difference between a sprain and a fracture. Some people may think that they have just sprained their hands when they’ve actually broken it. If a fracture is left untreated, it could result in permanent loss of mobility or permanent deformity.

Who to See & Types of Treatment Available

If you experience a fracture or if you suspect that you may have broken a bone in your hand, it’s best to proceed immediately to a hospital’s emergency department. Fractures are considered medical emergencies.

The doctor, most likely an orthopedic surgeon, will order an x-ray of the hand to determine the extent of the damage. The doctor will then set the bone into its proper position and apply a splint or cast to prevent the bone from being moved until it heals.

However, some fractures may require surgery, also referred to as an open reduction. The bone fragments will be held together by pins, plates, or screws. If the bone has been badly damaged and some parts are missing, the doctor will perform a bone graft.

A bone graft involves removing bone from other parts of the body and using it as a substitute for the missing bone. When setting the bone, a doctor will always aim for a perfect alignment. However, there are cases where this would be impossible but a perfect alignment is not always necessary to regain motion. But if the bones aren’t aligned, you can expect a lump on the surface where the fracture occurred.

After surgery or once the bone is set, the doctor will place a splint and a cast. The splint allows room for swelling to avoid complications. However, this does not guarantee that complications won’t happen. It’s important to remember that if you experience numbness or color change after the splint has been applied, it’s best to return to your doctor so that the splint can be adjusted. In any case, the doctor will usually have you report to the clinic or hospital after 24 or 48 hours for a follow-up consultation.

It will take some time for the fracture to heal. During this waiting period, care must be taken to prevent the bone from being displaced again. Once the bone is stable, the patient may begin to use the hand but may require physical therapy to help him or her regain as much motion as possible.

When the hand experiences a fracture, it’s likely that the wrist will be affected as well. The wrist bone, called a scaphoid, is also prone to fractures, especially when caused by a fall. However, unlike the bones in the hand, a scaphoid fracture may not appear in an x-ray immediately.

Don’t be surprised if the doctor places a splint on the wrist as well because a wrist fracture will only be visible on an x-ray after a couple of weeks. The doctor will then perform another x-ray to determine the extent of the condition.

Surgery is the primary form of treatment for wrist fractures. During surgery, the surgeon will use a screw or wire to hold the bones in place.

Unfortunately, there is a possibility that the scaphoid bone may not heal, even after surgery. In such cases, the surgeon will recommend a bone graft. This may involve using bone from other body parts or using other materials suitable for a graft.

Once the effects of the anesthetic subside after surgery, you’ll need medications to manage the pain. The doctor will prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to ease the pain.

References:

  • Webb CW. Metacarpal fractures. In: Eiff MP, Hatch RL, eds. Fracture Management for Primary Care. 3rd ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 4.
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