Hand Fractures
What is
a fracture?
The hand skeleton is made up of many bones
that form its supporting framework. This
frame acts as a point of attachment for the
muscles that make the wrist and fingers
move. A fracture occurs when force is
applied to a bone that is enough to break
it. When this happens, there is pain,
swelling, and decreased use of the injured
part. Many people think that a fracture is
different from a break, but they are the
same (Figure 1). Fractures may be simple
with the bone pieces aligned and stable.
Other fractures are unstable and the bone
tends to displace or shift. Comminuted
fractures (shattered bone) usually occur
from a high energy force and are often
unstable. An open (compound) fracture occurs
when a bone fragment breaks through the
skin. There is some risk of infection with
compound fractures.
How
does it affect the hand?
Fractures (or breaks) often take place in
the hand. A fracture can cause pain,
stiffness, and loss of movement. Because of
the close relationship of bones to ligaments
and tendons, the hand may be stiff and weak
after the fracture heals. Fractures that
involve joint surfaces may lead to early
arthritis in those involved joints.
How are
they treated?
Medical evaluation and X-rays are usually
needed so that your doctor can tell if there
is a fracture and to help decide treatment.
Depending upon the type of fracture to your
hand, your hand surgeon may recommend one of
several methods of treatment.
A splint or
cast may be used to treat a fracture that is
not displaced, or to protect a fracture that
has been set. Some displaced fractures may
be held in place with wires or pins without
making an incision. This is called closed
reduction and internal fixation.
Other fractures
may need surgery to set the bone. Once the
bone fragments are set, they are held
together with pins, plates, or screws
(Figure 2). Occasionally bone may be missing
or be so crushed that it cannot be repaired.
In such cases, a bone graft may be
necessary. In this procedure, bone is taken
from another part of the body to help
provide more stability.
Fractures that
have been set may be held in place by an
“external fixator,” a set of metal bars
outside the body attached to pins which are
fixed to the bone above and below the
fracture site until the break heals.
What
kind of results can I expect?
Perfect alignment of the bone on X-ray is
not always necessary to get good function. A
bony lump may appear at the fracture site as
the bone heals and is known as fracture
callus. This functions as a “spot weld.”
This is a normal healing process and the
lump usually gets smaller over time.
Problems with fracture healing include
stiffness, shift in position, infection,
slow healing, or complete failure to heal.
Smoking has been shown to slow fracture
healing. Fractures in children occasionally
affect future growth of that bone. You can
lessen the chances of complication by
carefully following your hand surgeon’s
advice during the healing process and before
returning to work or sports activities. A
hand therapy program with splints and
exercises may be recommended by your
physician to speed and improve the recovery
process.
Figure 1
Examples of fractures in fingers.
Figure 2
Examples of plates, pins, and screws used to
join fractures while they heal.
Copyright ©
American Society for Surgery of the Hand
2001
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