HAND FRACTURES

GENERAL



There are 27 bones in the hand and wrist. A fracture occurs when excess force is applied to a bone. This may occur with a twist, cutting or crushing injury or commonly from a fall onto the outstretched hand. When the forces are severe the bone may end up in multiple pieces or become significantly displaced resulting in a deformity. An open (or compound) fracture is when a bone fragment shows through the skin and is at risk of infection.

Many people think that a "fracture" is different from a "break", but they are the same.

EFFECT ON THE HAND

The forces causing a fracture may also injure other structures such as muscles, tendons and ligaments.

When a bone breaks there is bleeding from the bone ends.

Bleeding leads to scarring which results in stiffness particularly in the fingers.

If a fracture involves the joint surface then arthritis may develop later in life.


FRACTURE TYPES

• Stable.
• Unstable.
• Undisplaced (rotated, short, bent).
• Joint Involved - Step ( __---- ) or Gap ( ---- ---- ).
• Bone Quality - Osteoporosis.
• Number Bone Fragments - Comminution.
• Growth Plate Involved (children).
• Acceptable.
• Unacceptable.

TREATMENT PRINCIPLES

1. Reduce Swelling

• Ice Packs.
• Elevation.
• Coban.

2. Control Pain

• Splint.
• Pain Killers.

3. Prevent Stiffness - early movement if the fracture is stable (even before the fracture has healed).

4. Stabilise the unstable.

5. Correct Deformity

• Rotation.
• Angulation.
• Shortening.
• Joint Step (> arthritis).

"Reduction" means pulling the bones back into place. This can be done "Closed" in which no cut is made and a plaster or splint is applied or "Open" where a cut is performed and the bones are directly repositioned .An open reduction often requires the use of wires, plates and screws. An External fixateur is where metal bars outside the body connect pins extending into the bone above and below the fracture site.

Occasionally bone is missing or severely crushed and so bone graft may be taken from some other part of the body (often the hip) to fill the defect and help bone healing.

RESULTS

Perfect alignment of the bone on X-ray is not always necessary to get an excellent result. A bony lump may appear at the fracture site as the bone heals and is known as "fracture callus". This is a normal part of the healing process and usually gets smaller over time.



Stiffness is the commonest problem and so movement is started as soon as it is safe to do so. Please closely follow the recommendation of your surgeon and hand therapist.

Occasionally loss of bone alignment occurs and additional treatment may be required.

In general it takes 6 weeks for a hand fracture to heal. Often it takes much longer for the x-ray to show signs of healing (3-5 months). This is variable so carefully follow instructions.