Hand Fractures

To make the fingers and hand move, there's a frame of bones inside the hand that are attached to muscles. If one of those bones is hit hard enough, or gets enough pressure put on it, the bone will break and cause a fracture.

You will know when a bone has been fractured because there will be pain, swelling, and the injured part may not work the same. A fracture isn't any different from a break and sometimes, if the pieces are still aligned and don't move, are called simple fractures. Other times, the pieces that were broken can move around. Some fractures happen in the main part of the bone, the shaft, but others happen near the joints.

If the bone is shattered into many pieces, it is referred to as a comminuted fracture, and usually results from a strong blow. An open or compound fracture is when a bone fragment pokes through the skin, which means there is a danger of infection.

Signs & Symptoms

A fracture involving any of the many bones in the hand usually ends up causing pain, stiffness, or the loss of some movement in either the hand or fingers. Sometimes the fracture will cause something very noticeable, like a crooked finger, but other times there is no visible change. Because the bones in the hand work closely with the tendons and ligaments that are attached to them, even after the fracture heals, the hand may still be weak or stiff. If the fracture happened near one of the joints or knuckles, arthritis can develop in the affected area.

Treatment of Fractures

Before any treatment is decided on, your doctor will usually examine your hand and take some x-rays to see the damage. There are several treatment options, which depend on the type and location of the fracture.

If the bone didn't move when it was fractured, or has been set by a hand doctor, either a splint or cast may be used to keep the bone in place. If the bone was moved when the fracture happened, it may need to be held in place with a screw, a plate, or pins. If this can be done without cutting the hand open, it's called a closed reduction and internal fixation.

If a hand surgeon needs to perform surgery to put the bone in place, it is referred to as an open reduction. After the fragments of the fractured bone are set back where they belong, pins, plates, or screws are used to hold them together. Articular fractures, those that change the normal working of a joint, usually need to be restored very precisely and delicately to keep the surfaces of the joint as smooth as possible.

If the bone was fractured so badly that pieces of it are missing or can't be fixed, a bone graft from somewhere else in the body may be necessary to help restore stability.

An external fixator, a set of metal bars on the outside of the injured part that use metal pins above and below where the bone was fractured, may be used after the fracture has been set in place. This device acts like a traction device and stops the bone from moving until it is fully healed.

After the fracture has healed enough to be stable, you may be given a set of motion exercises to perform to keep the area flexible. Your hand doctor will only prescribe these exercises after your hand or finger fracture has become stable enough to perform them.

Recovery & Therapy

It's not always possible or even necessary for the bone to end up perfectly aligned after surgery for you to have full use of your hand after surgery. Sometimes the bone will heal with what's called a fracture callus, which is a bony lump where the bone fused back together. This is normal, and the bump often gets smaller as time passes.

As a fracture heals, you may have stiffness in your hands or fingers, the bone may shift a little, the area may become infected, or the bone may heal slowly or not at all. Smoking has been shown to slow down the time it takes a fracture to heal, and if a child has fractured a bone in his or her hand or finger, that bone's later growth may be affected.

These complications can be avoided, or the chances of them showing up can be reduced, by carefully following the advice your hand surgeon gives you when the bone is healing and before you go back to work or start using your hand again actively. To speed up the healing process and increase the chances of getting full use of your hand back after a hand fracture, you should expect to get a hand therapy program that includes splints to hold the bone in place and exercises to do by your hand doctor.