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Hand Fractures
The hand 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 enough force is applied to a bone 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 (see Figure 1). Fractures may be simple with the bone pieces
aligned and stable. Other fractures are unstable and the bone fragments
tend to displace or shift. Some fractures occur in the shaft (main body)
of the bone, others break the joint surface. Comminuted fractures (bone
is shattered into many pieces) 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.
Fractures often take
place in the hand. A fracture may cause pain, stiffness, and loss of
movement. Some fractures will cause an obvious deformity, such as a crooked
finger, but many fractures do not. 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.
Medical evaluation and x-rays
are usually needed so that your doctor can tell if there is a fracture
and to help determine the treatment. Depending upon the type of fracture,
your hand surgeon may recommend one of several treatment methods.
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 need to be set and then 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 (open reduction). Once
the bone fragments are set, they are held together with pins, plates,
or screws (see Figure 2). Fractures that disrupt the joint surface (articular
fractures) usually need to be set more precisely to restore the joint
surface as smooth as possible. On occasion, bone may be missing or be
so severely 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 placed in the bone above and below the fracture site, in effect
keeping it in traction until the bone heals.
Once the fracture has enough stability, motion exercises may be started
to try to avoid stiffness. Your hand surgeon may determine when the fracture
is sufficiently stable.
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 a “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.
Examples of fractures in fingers.
Examples of plates, pins, and screws used to join fractures
while they heal.
© 2007 American Society for Surgery of the Hand
Developed by the ASSH Public Education Committee
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