Hand Fractures Diagnosis and Treatment

A hand fracture occurs when one of the small bones of the hand is broken. There are several small bones that together make up the supporting framework of the hand. These are the small finger bones, known as the phalanges; and the long bones, known as the metacarpals.

Causes

Most hand fractures occur as a result of direct trauma to the hand—either an object falls on the hand or the hand strikes an object. But you can also break a hand bone with a twisting injury or in a fall.

Symptoms

When a hand fracture occurs, common symptoms include:

• Pain
• Swelling
• A palpable deformity, which may include a shortened finger or a depressed knuckle
• Difficulty moving the fingers
• A finger that crosses over the one next to it when you try to make a fist.

Diagnosis

When you suspect your hand is broken, your healthcare provider will examine it for deformity, mobility, and strength. Then she will get X-ray studies to determine if a bone is broken. If a fracture is seen in one of the bones of the hand, a decision will be made to determine the appropriate treatment for the injury.

There are times when a fracture may not be apparent on an X-ray but may be suspected based on your symptoms or the way the injury occurred. In these cases, other tests, such as CT scans and MRIs, can be helpful in detecting subtler injury.

Another evaluation method is to treat as if a fracture has occurred, and then X-ray the hand again in one to two weeks. Typically, by that time, some healing has occurred, and the fracture that was not apparent should become more visible.

Treatments

Possible treatments of a broken hand include:

• Cast and splints: If the fracture is not displaced (meaning, it is in the proper position), a cast or splint will likely be sufficient for treating the fracture. Furthermore, there are some types of hand fractures that do not necessarily need to be in a perfect position in order to heal properly. These fractures may be cast or splinted and allowed to heal.
• Pins: Small metal pins may be inserted through the skin in order to hold the bones in a better position. This procedure is usually done with the patient under general anesthesia, but may also be done with a local anesthesia block. The metal pins remain in place for several weeks while the fracture heals, and then the pins can usually be removed in the office.
• Metal plates and screws: In some unusual types of hand fractures, further treatment may be necessary. In these cases, metal screws with either a plate or an external fixator can be used to help maintain proper alignment of the bones.

You may have follow-up appointments including X-rays to see if the hand is healing correctly. Your healthcare provider will also want to see whether there is any tightness in the joints during healing.

Problems During and After Healing

Most hand fractures will heal uneventfully. The two most common problems patients who sustain a hand fracture will face are stiffness of the fingers and a noticeable bump. The bump is usually a result of extra bone the body forms as part of the healing process. While the bump does diminish in size over time, it may never completely go away.

Finger stiffness is prevented by beginning motion as soon as possible. It is sometimes necessary to work with a specialized hand therapist in order to help regain finger motion.