Hand Fracture Treatments

Introduction to Hand Fractures: Causes and Symptoms

Hand fractures are common injuries that can result from accidents, sports injuries, or falls. The intricate structure of the hand, consisting of numerous bones, joints, ligaments, nerves, arteries, and veins, makes it important to diagnose fractures. Symptoms of a hand fracture often include pain, swelling, deformity, and limited mobility. Understanding the cause, diagnosis, and treatment options is crucial for effective management and recovery from a hand fracture.

Anatomy of the Hand: Understanding the Injury

Understanding the implications of a hand fracture requires a grasp of the intricate anatomy of the hand. The hand is a marvel of biomechanical engineering, comprising three major groups of bones that collaborate harmoniously: the carpal bones, which form the wrist’s foundation; the metacarpal bones, extending from the wrist to the base of the fingers; and the phalanges, the delicate bones that constitute the fingers themselves. The harmony of these bones enables the intricate movements and functions the hand performs daily.

Fractures can arise within any of these bone groups, creating a spectrum of injury scenarios. Carpal fractures, which primarily occur at the wrist, can disrupt the hand’s alignment and motion coordination. Metacarpal fractures, found in the palm area, can jeopardize gripping ability and manual dexterity. Finally, fractures in the phalanges can undermine the precise movements vital for tasks as complex as playing a musical instrument or as fundamental as buttoning a shirt.

The specific location and severity of the fracture play a pivotal role in determining the treatment strategy. Each bone group’s unique contribution to hand function underscores the necessity of tailoring treatment to the type and extent of the fracture, aiming to restore not just bone integrity, but the intricate dance of hand motions that define human interaction with the world.

Type of Hand Fractures

There are several different types of hand fractures, each categorized based on the specific bone involved and the nature of the fracture. Here are some common types of hand fractures:

Phalangeal Fractures: Phalanges are the bones of the fingers. Fractures in this area are classified based on which part of the phalanges is affected:
- Proximal Phalanx Fractures: These occur in the bones closest to the hand.
- Middle Phalanx Fractures: These occur in the middle section of the fingers.
- Distal Phalanx Fractures: These occur in the bones at the fingertips.
Metacarpal Fractures: Metacarpals are the long bones in the palm of the hand. Fractures in this area are often referred to by the number of the metacarpal affected, such as “first metacarpal fracture” for the thumb.
Boxer’s Fracture: This refers to a specific type of fracture that occurs when the fifth metacarpal bone (connected to the pinky finger) is broken due to direct impact. It’s often seen in cases of punching or striking an object.
Bennett’s Fracture: A Bennett’s fracture occurs at the base of the first metacarpal bone, where it connects with the wrist. It’s typically caused by a forceful blow to the thumb.
Rolando Fracture: Similar to a Bennett’s fracture, a Rolando fracture also occurs at the base of the first metacarpal but is more complex, often involving multiple fracture fragments at the wrist joint.
Scaphoid Fracture: The scaphoid bone is one of the carpal bones in the wrist. Fractures of the scaphoid are common and can be tricky to diagnose because the symptoms might mimic a wrist sprain.
Radial and Ulnar Fractures: These fractures involve the radius and ulna bones in the forearm. While not strictly hand fractures, they can affect hand movement and function.
Phalangeal Neck Fractures: These fractures occur near the neck of the phalanx and can involve fractures that extend into the joint, potentially leading to joint problems if not properly treated.
Avulsion Fractures: These occur when a piece of bone is pulled away from the main bone by a tendon or ligament. These can happen in various parts of the hand.
Open Fractures: In these fractures, the broken bone is exposed through the skin, increasing the risk of infection and complicating the healing process.
Comminuted Fractures: In this type of fracture, the bone breaks into multiple fragments. These fractures can be more complex and may require surgical intervention.
Greenstick Fractures: Often seen in children, a greenstick fracture is an incomplete fracture where the bone bends and partially breaks, similar to a green twig bending.

It’s important to note that the treatment approach for each type of hand fracture can vary based on factors such as the location, severity, and displacement of the fracture. A thorough evaluation by a hand surgeon is essential to determine the appropriate treatment plan for a specific type of hand fracture.

Diagnosis of a Hand Fracture: Examination and Imaging

Timely medical attention is crucial if a hand fracture is suspected. An orthopedic hand surgeon will conduct a thorough examination, considering symptoms and potentially ordering imaging tests, such as X-rays, to confirm the diagnosis and assess the extent of the fracture.

Non-Surgical Treatments for a Hand Fracture

Non-surgical treatments can often effectively manage and promote healing of hand fractures.

Immobilization: Splints and Casts

One of the primary treatment approaches for hand fractures is immobilization. A splint or cast is used to immobilize the hand and to aid proper alignment of the fractured bones as they heal. The duration of immobilization varies based on the type and severity of the fracture. Reduction and realignment under local anesthesia may be required.

Pain Management: Medications and RICE

Your hand surgeon may recommend pain medications, both over-the-counter and prescription, to alleviate the discomfort associated with a hand fracture. Additionally, home remedies like ice packs and elevation may help reduce swelling and pain.

Surgical Treatments for a Hand Fracture

Hand surgery might be necessary in cases where the hand fracture is complex, unstable, or significantly displaced.

Indications for Surgery

Hand surgery is generally recommended when the fracture is displaced, involves a joint, or when non-surgical treatments fail to align the bones properly. The decision for hand surgery is influenced by factors such as the specific bones affected, the degree of displacement, and individual patient needs. Only a board certified hand surgeon can determine the best treatment plan.

Different Surgical Procedures for Hand Fractures

Several surgical techniques can be employed to treat hand fractures:

Closed Reduction and Percutaneous Pinning: In this technique, the hand surgeon manually repositions the fractured bones without making an incision. Small pins or wires are inserted through the skin and into the bones to hold the fragments in place during the healing process.
Miniature Fragment Plate Fixation: Small plates specifically designed for hand fractures are used to stabilize the fractured bones. The plates are secured to the bones using screws by the hand surgeon, providing stability and promoting proper healing.
Open Reduction and Internal Fixation (ORIF): This procedure involves a hand surgeon making an incision to access the fractured bones. The hand surgeon then repositions the bone fragments into their proper alignment and uses screws, plates, or wires to stabilize them.
External Fixation: This hand fracture treatment involves the use of an external device to stabilize the fractured bones. Metal pins or wires are inserted through the skin and into the bones, and these pins or wires are connected to an external frame outside the body. This provides stability and promotes proper healing.
Intramedullary Fixation: In this procedure, a specially designed metal rod or screw is inserted into the medullary canal (the hollow center) of the fractured bones. The rod or screw acts as an internal splint, providing stability and facilitating bone healing.
Bone Grafting: In cases where there is a significant loss of bone or a non-healing fracture, a bone graft may be necessary. This procedure involves taking bone tissue from another part of the body (autograft) or using donor bone (allograft) to fill in the gaps and promote bone healing.
Tension Band Wiring: This technique is often used for fractures in which the bones experience tension forces when the hand is used. A wire is passed around the fractured bones in such a way that it converts the tension forces into compression forces, facilitating proper healing.
External Fixation with K-wires: This method involves using K-wires (thin, flexible wires) that are inserted through the skin and into the fractured bones. The wires are then connected to an external frame outside the body, providing stability and promoting healing.
Arthroscopy-Assisted Reduction: In some cases, minimally invasive arthroscopic techniques can be used to assist in the reduction (realignment) of fractured bones. This involves using a small camera and specialized instruments inserted through tiny incisions.

It’s important to note that the choice of surgical procedure depends on various factors, including the specific bones involved, the nature of the fracture, and the overall condition of the patient. The treating orthopedic surgeon will determine the most appropriate surgical approach based on these factors and the individual patient’s condition.

Rehabilitation and Exercises for Hand Fractures

After the initial healing phase, rehabilitation and exercises play a crucial role in restoring hand function, strength, and mobility.

An occupational therapist will collaborate with you and your hand surgeon to develop a personalized rehabilitation plan. This plan might involve exercises to enhance range of motion, strength, and flexibility of the hand. Functional activities could be integrated to improve coordination and dexterity. It’s vital to adhere to the therapist’s guidance and attend all scheduled rehabilitation sessions to achieve the best recovery.

Tips for Speedy Recovery from Hand Fractures

To expedite recovery and ensure optimal healing, consider these tips:

Follow the Treatment Plan: Adhere to the prescribed treatment plan provided by your healthcare provider.
Immobilization: Keep the hand immobilized as instructed to prevent further injury.
Pain Management: Take prescribed pain medications as directed for pain relief.
Rehabilitation: Attend all rehabilitation sessions and diligently perform recommended exercises.
Overall Health: Maintain good health with a balanced diet, sufficient rest, and avoiding activities that strain the hand.

Prevention: Reducing the Risk of a Hand Fracture

While preventing all injuries might be challenging, these steps can lower the risk of a hand fracture:

Hand Protection: Use hand protection during activities with a high risk of injury, like sports or manual labor.
Technique: Practice proper technique to minimize strain on the hands during physical activities.
Safe Environment: Maintain a safe environment to prevent falls or accidents that could lead to hand injuries.
Rest and Strengthening: Take breaks during repetitive tasks and perform exercises to strengthen your hands.

Do You Think You Have a Hand Fracture?

In conclusion, understanding the causes, diagnosis, and treatment options for hand fractures is crucial for effective management and recovery. Non-surgical treatments are often effective, while surgical interventions may be necessary for more complex fractures. Rehabilitation and exercises play a critical role in restoring hand function. By taking preventive measures and practicing hand safety techniques, the risk of hand injuries can be reduced.

If a hand fracture is suspected, consult a hand surgeon immediately. Dr. Mark E. Pruzansky and Dr. Jason S. Pruzansky.