Hand fractures may occur in any of the bones of the hand. This injury must be treated immediately if the hand is to regain its natural range of motion.
Damaging a bone in the hand will almost always shift it out of place. This will pull on the soft tissues surrounding other bones, which will result in misalignment of multiple joints, creating painful and inconvenient symptoms. Fractured bones may also put abnormal pressure on the soft tissues, leading to inflammation. This can cause more permanent tissue damage that will leave the hand stiff, making simple gripping and bending motions difficult.
Each finger contains three phalanges bones, decreasing in length towards the tip of the finger and connected by small joints. The longest phalanges attaches to one of the five metacarpal bones in the hand at the knuckle. Ligaments and tendons form a complex web around the bones and joints, holding them in place and connecting them to the muscles of the forearm that allow us to move our fingers.
CAUSES
Hand fractures most often occur in athletes. Damage to the hand is usually the results of a fall or an injury during contact sports. A common sports-related hand fracture is called “boxer’s fracture.” Boxers often damage their fifth metacarpal, the bone of the outermost part of the hand, which is vulnerable to forceful impact when making a fist.
SYMPTOMS
Hand fractures typically cause pain and swelling. Symptoms may be difficult to detect visually, but there is usually mild to severe pain. Whether it occurs in the phalanges or metacarpals, a hand fracture will make it difficult to bend the fingers or grip an object. Further symptoms include:
- Pain increasing upon movement
- Bruising of the area
- Obvious deformities such as a shortened finger, a depressed knuckle, or a finger that crosses over the other fingers when attempting to make a fist
- Swelling and tenderness
- Numbness/ tingling when severe swelling leads to nerve impingement
DIAGNOSIS
Your physician will be able to diagnose a hand fracture through physical examination. The orthopedic hand doctor will check for nerve damage and impaired blood flow to the hand first. X-rays will be used initially to provide a quick image of the disrupted bone structure. A CT (computerized tomography) scan or MRI (magnetic resonance imaging) will create a more detailed image of the bones and soft tissues that have undergone damage along with the fracture. Imaging tests help the orthopedic hand doctor determine the best treatment options for their patients.
By examining the severity of misalignment and tissue damage, an orthopedic hand doctor can decide whether or not surgery is necessary to fix the hand fracture, or if immediate immobilization followed by physical therapy will be sufficient.
TREATMENT
If a hand fracture is not treated quickly enough it could heal improperly, resulting in permanent damage and future problems.
NON-SURGICAL HAND FRACTURE TREATMENT
Typical hand fractures can be properly healed through non-surgical means. Your orthopedic hand doctor at New York Bone and Joint Specialists can manipulate misaligned bones back into place. The bones will then be held in this position by a cast or splint that completely immobilizes your hand. To ensure that your hand stays in this set position, the brace will extend to your forearm, where tendons of the hand reach muscles of the arm.
Due to the delicate healing of the hand’s musculoskeletal structure, follow up x-rays are taken after a week or so of immobilization so your orthopedic hand doctor can ensure that the fracture is healing properly. The brace will stay in place for at least three weeks, but may be necessary for up to six weeks. When the cast or splint is removed, physical therapy should begin.
REHABILITATION
Physical therapists will begin recovery of your hand fracture by slowly stretching the soft tissues in the area. This will reduce stiffness so that daily tasks, like gripping a cup or zipping a sweater, can be done easily. Strengthening will begin gradually, so that your hand regains its range of motion and may be moved and rotated without pain and with fluidity. You may even find that a broken finger appears shorter than it did before. While the bone of the finger may have less bone mass than before, making it smaller, this does not affect the functionality of the appendage.
SURGICAL TREATMENT
In more traumatic instances, a hand fracture could require surgery to save the shape and functionality of your hand. These cases cause more tissue damage, and tissues are not so easily repaired as bone. This is usually necessary when:
- There are multiple fractures or bones have shattered, as is common in motor vehicle accidents
- A bone is knocked severely out of place
- A fracture extends to a joint in the hand
- A loose fragment from a fracture is loose within a joint making the entire hand extremely unstable
There are various ways in which your orthopedic hand surgeon will repair a hand fracture. In many cases, wires, screws, or plates will be used to hold fractured bone together until they heal. These implants may even remain in the hand after healing to provide extra support in the future.
POST-OPERATIVE REHABILITATION
A long immobilization period is needed following hand fracture surgery so that delicate soft tissues have a chance to heal themselves along with the fractured bone. A checkup will be required periodically to determine if the bones are healing out of place, which may happen if damaged tissues become too stiff. If your bone heals out of place, you will notice that it bends in abnormal directions when making a fist or gripping an object. The experts at NY Bone and Joint Specialists are extremely successful in restoring a hand fracture to its original form and functionality.
It is important to adhere to the limitations set by your orthopedic surgeon and physical therapist when rehabilitating your hand. Because of the extended period of immobilization, your healing hand will be stiff when the cast is removed.
Physical therapy is crucial in regaining mobility in the area. Stretching will break any calcified tissue masses that may have formed as ligaments and tendons healed. The guided stretches will slowly restore flexibility. Strengthening the muscles of your forearm will help increase range of motion in your hand. While rehabilitation may take a period of months, following a steady physical therapy regimen will drastically improve the outcome.
