Hand Fractures

Article by Dr. Darren R Keiser MD

Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports. A physical examination is done to check the position of the fingers and the condition of the skin. The examination may include some range of motion tests and an assessment of feeling in the fingers. This will ensure that there is no damage to the nerves. X-rays identify the location and extent of the fracture.

Treatment

Nonsurgical Treatment
Most of the time, the bones can be realigned by manipulating them without surgery. A cast, splint or fracture-brace is applied to immobilize the bones and hold them in place. The cast will probably extend from the fingertips down past the wrist almost to the elbow. This ensures that the bones remain fixed in place.

A second set of X-rays will probably be needed about a week later. These X-rays are used to ensure that the bones have remained in the proper position.

The cast will be worn for three to six weeks. Gentle hand exercises can probably be started after three weeks. Afterward, the finger may be slightly shorter, but this should not affect the ability to use the hand and fingers.

Surgical Treatment
Some hand fractures require surgery to stabilize and align the bones. These fractures usually break through the skin or result from a crushing accident. An orthopaedic surgeon can implant wires, screws, or plates in the broken bone to hold the pieces of the fractured bone in place. If the bone changes position while healing, the finger may lose some function.

After the bone has healed, the surgeon may remove the implants or may leave them in place.
The physician may want to examine the hand periodically to ensure that the joint doesn’t tighten (contract) during healing.

Joint stiffness may be experienced because of the long immobilization period. Exercises can help restore strength and range of motion. A physical therapist may be able to help with this.

**Call the office of Dr. Darren Keiser to set up an appointment

Article URL: http://orthoinfo.aaos.org/topic.cfm?topic=A00010&webid=2FDDE053