The carpal bones, metacarpals and the phalanges (fingers) form the structural frame of the hand. Fractures of the hand can be non-displaced or displaced. Non-displaced fractures are those that have not lost normal alignment. Bone ends are shifted with displaced fractures and require realignment. Fractures can be comminuted (shattered) or open communicating with the skin and other soft tissues. Risk of infection can be higher in the case of bone protruding through the skin.
WHAT ARE THE SYMPTOMS OF A HAND FRACTURE?
A hand fracture or break may produce pain, swelling or deformity (if displaced) and loss of movement of the adjacent joints.
HOW IS A HAND FRACTURE DIAGNOSED?
A medical evaluation by a physician and x-rays are both needed to properly diagnose a hand fracture.
WHAT IS THE TREATMENT FOR A HAND FRACTURE?
Conservative treatment consists of immobilization with a splint or cast usually for stable non-displaced fractures. Surgery may be necessary for a displaced unstable fracture to set the bones back into alignment and hold them together with pins, screws or plates. If alignment of the fracture can be done without an incision into the skin and held by pins, it is called a closed reduction and internal fixation. If an incision is required to set the fractured bone, it is called an open reduction and internal fixation.
When the bones are severely comminuted (shattered) or a bone is partially or totally missing, a bone graft may be necessary to reconstruct the fractured bone. A piece of bone is usually taken from the hip or the end of the wrist to replace the missing bone.
The length of the immobilization period depends on the bone(s) involved and the type of fracture. For example, scaphoid fractures (carpal bones) usually need more immobilization time to achieve complete healing. Open fractures can heal slowly due to the injury of the soft tissue surrounding the fracture. Possible complications include stiffness, infection, crooked healing, slow healing process and sometimes complete failure to heal. Smoking is known to slow or diminish the fracture healing process.
After a fracture has healed, the physician may recommend a rehabilitation program to improve recovery. Initially, a home exercise program may be initiated and in some cases, physical therapy is advised.