Hand fractures (or a “broken hand”) can involve either:
Metacarpal bones: the 5 bones in the palm of the hand (as shown broken in the image above)
Phalanges: the 14 bones within the fingers – two in the thumb, three in each other finger
Pain and stiffness
Bruising and swelling
Deformity: either a crooked finger, or a rotated finger
X-rays are an important tool for evaluating fractures and determining the optimal treatment. This helps to identify if the fracture is “stable” or “unstable”, and assess how much “displacement” (or shifting between the broken bones) is present at the fracture site.
Examining the hand is also important to look for abnormal alignment, resulting in a finger appearing “crooked”. Some fractures may also be rotated. When attempting to make a fist, a rotated finger will cross over (or scissor with) the neighboring finger. This is usually poorly tolerated, and these fractures tend to be treated with a reduction (see below).
Stable fractures, or minimally displaced fractures, can oftentimes be treated in a cast or splint until the bone heals.
When the fracture is unstable, notably angulated, notably shifted, or rotated – better outcomes may be achieved with surgery. This may involve setting the bone and placing metal pins across the fracture through the skin.
Occasionally, an incision may be required to line up the fragments of bone and hold them in place with a metal plate and screws. There are many different small metal plates and screws designed to fit along the bones within the hand.
The optimal treatment depends on the fracture, its location and alignment, and the state of the skin and other soft tissues around the injury.
Regardless of treatment type, some pain and stiffness is not unexpected throughout the healing process, and therapy is oftentimes used to achieve optimal motion, strength, and function of the hand.
Dr. Schreiber is a board certified orthopedic surgeon specializing in hand, wrist, and elbow conditions. Dr. Schreiber practices at the Raleigh Orthopaedic Clinic in Raleigh, North Carolina.