Download Information leafletFractures in the hand
What is it?
Fractures in the hand could involve any of the many bones. Injuries and fractures to the hand are common. They may occur after falls, direct impacts or crushing injuries.
What are the symptoms and how is the condition diagnosed?
Immediate pain will be felt in the affected part of the hand. The hand / fingers will immediately swell and bruise. The finger will be deformed if the fracture is significantly displaced or associated with a dislocation. The patient will not be able to move the finger.
X-rays: The diagnosis of these fractures can only be confirmed by an x-ray. The pattern of fracture seen on the x-rays will determine the treatment. The x-rays will show the Specialist how much the bones have moved apart (displaced), whether the fracture extends into the joint (intra-articular), and the number of bone fragments (comminution).
Sometimes patients may also sustain a wound, and the fracture is called an ‘open fracture’. Open fractures are treated urgently to prevent further soft tissue damage and infection. Symptoms like tingling, numbness and discolouration suggest pressure on the nerves or blood vessels.
Will further tests or investigations be needed?
In addition to the initial x-ray your specialist may, in certain cases of hand fractures, advice further investigations (usually CT) before planning treatment.
What is the treatment for acute fractures?
The general principle in treating any hand fracture is to reduce the displaced fracture to an improved position and hold it in place, but most importantly to start mobilising the hand and fingers. This helps the soft tissue and tendons to glide and prevent stiffness. Fingers are notorious to get stiff after an injury, so early mobilization of the hand is extremely beneficial.
The method by which this can be achieved is dependent on the location of the fracture; the state of the soft tissues; whether the fracture extends into the joint; the degree of fracture displacement; the extent of comminution (fracture fragments); the quality of bone stock and the functional demands of the patient. If it is an open fracture, the wound needs to be cleaned, debrided, and the fracture stabilized as soon as possible.
- Conservative treatment with / without a splint:
The majority of hand fractures will be stable and can be treated by painkillers, elevation of the hand and moving the fingers straightaway. Sometimes a splint is given for support or the broken finger is strapped to the neighbouring finger that acts as a splint. Elevation is important as it will both reduce and prevent swelling. Any rings on the fingers need to removed. - Closed reduction and K-wire fixation:
This is the most common technique used during which the fracture is reduced under local or general anaesthesia and held with pins (k-wires). The wires are inserted through the skin. If inserted correctly the finger can be mobilised soon afterwards. Sometimes the K-wires are not strong enough and can come out or become infected. Regular follow-up is essential in the initial weeks. Pins are removed after 4-6 weeks. - Surgical treatment by open fracture reduction and internal fixation:
With this technique, an open approach is used and the fracture exposed, reduced and held in place by screws or plates (picture below). Such surgery is sometimes practiced in open fractures; unstable fractures (significantly comminuted, shortened, rotated or displaced); in patients who have sustained multiple fractures. Whichever technique is used it should be followed by early motion.
- Surgical treatment by closed fracture reduction and external fixation:
Some finger fractures may be associated with a dislocation or are so comminuted and unstable that both the above techniques may fail. In such complex fractures an external fixator may be used. Pins are inserted into the bone and a frame is constructed by connecting them to another pin / rod outside of the skin. Traction is applied before tightening the frame. The fracture is reduced to the best possible position and movement of the finger and joint is encouraged (picture below).
What happens if it is not treated?
If appropriate advice and hand therapy is not sought for these fractures, the fractures may heal with a deformity (picture below). Significant hand stiffness will follow. Intra-articular fractures will soon lead to joint arthritis.
What is the success of treatment?
Properly treated hand fractures will lead to a successful functional result. Certain fractures (especially those that occur around the middle knuckle of the finger) may not be so successful.
If there has been significant damage to the soft tissues (high-energy injuries), the eventual outcome will be compromised. Fractures usually take 6 weeks to heal but movement and strength will continue to recover over 6-9 months.
What are the complications of treatment?
- Hand and finger stiffness.
- Infection of the wound is possible and can usually be successfully treated with antibiotics.
- Poor strength and grip.
- Unsightly scar.
- The implants may have cause problems and need to be removed The bones may still fail to unite after surgery.
- Severe complex regional pain syndrome (CRPS) is a rare but serious complication after hand surgery. Unfortunately it is not possible to predict this problem but it needs to be monitored and treated (usually with just physiotherapy) if it develops.
- Any surgical intervention has the risk of developing complications, which are unpredicted. These complications may have the potential to leave the patient worse than before surgery.
Is there anything I can do to improve the outcome?
Keep the wounds dry and clean until they have healed.
Whether you have an operation or not, it is very important to mobilize the fingers. It is important to practice the prescribed exercises regularly both during the therapy sessions and at home. It will help to keep the pain levels down with analgesics so as to keep your shoulder, elbow and hand fingers moving.
It is advised against wearing rings on the injured side for 4-6 weeks after surgery.
When can I do various activities?
Return to work depends on many factors including the nature of the job, hand dominance and the nature of your fracture. The advice will vary individually and this is best discussed with the Specialist.
