Fractures of the Hand and Wrist

Good hand function depends on healthy and intact bones and joints. 31 bones from the skeleton of the hand and wrist. Between the bones are joints that allow the fingers and wrist to move. Muscles and tendon attach to the bones, moving the joints when they contract and relax. The nerves and blood vessels are supported and protected by the solid bones.

Hand Anatomy

With sudden forceful impact or twisting, the bones may break causing a fracture. This can happen when one breaks a fall with the hand; during sporting activities particularly contact sports such as marital arts, basketball or football; in traffic accidents, or when working with tools. When this happens, pain, swelling and deformity will severely impair hand function. In more severe injuries, the soft tissues such as nerves and blood vessels may be injured, jeopardising the entire finger or hand. All fractures and dislocations must be treated quickly and properly to ensure that good hand function is restored.

How do I know if There is a Fracture?

If you have hit or twisted your finger or wrist, or fallen hard on your hand, you may have fractured a bone. If the hand or wrist is obviously deformed and looks abnormal, then there is probably a bad fracture or dislocation. However, even if there isn’t any obvious deformity but there is swelling, bruising and pain when trying to move a finger or wrist, then you should suspect there is a fracture.

Wrist Fracture

When Should I see a Doctor?

If you think you may have a fracture or dislocation, it is important to see a doctor as soon as possible to have an X-ray taken. X-rays show the bones and joints under the skin, revealing any breaks in the bone or dislocated joints. You should see a doctor immediately if you also have an open wound, numbness in the injured finger or hand, or if the injured finger is turning blue or pale. These are signs that there is also injury to the skin, nerves and blood vessels respectively, all of which need urgent surgical treatment.

Can I use traditional or “alternative” medicine instead?

You should never allow a “bone setter”, chiropractor or traditional medicine practitioner to manipulate an injured finger, hand or wrist without an X-ray confirming that there isn’t a fracture or dislocation.

Such manipulation may cause more injury or delay the diagnosis, making the treatment more difficult and the outcome poorer.

How are the fractures treated?

All fractures require immobilisation of the bone to allow it to heal. Usually, healing takes six weeks for adults and three to four weeks for children. During this time, the broken bone ends and the joints at either end of the fractured bone must be immobilised. Fractures that are displaced or deformed need to be manipulated to make the bone straight and bring the ends together to allow them to heal without deformity. The most common way to immobilise the fracture is to put the hand or wrist in a cast. However, some fractures are too unstable and may shift in the cast. A surgery called “open reduction internal fixation” or ORIF is needed to fix them with metal wires, plates or screws. ORIF is also necessary when perfect alignment is needed. Even simple fractures that are not badly displaced can benefit from ORIF, which allows immediate use of the hand, instead of putting it in a cast for four to six weeks.

Physical therapy is frequent needed after the fracture heals to regain mobility, strength and function in the hand. If the fracture has been fixed surgically, therapy starts immediately after surgery, without waiting for it to heal, as the metal implants prevent the fracture from moving. This allows much faster return to full function.

What is the outcome?

It is vital for hand and wrist fractures to be treated by an experienced orthopaedic surgeon. Poorly fixed or badly managed fractures result in permanent deformity and stiffness, greatly impairing hand function. More complex surgery may be needed later to correct the deformity and restore function. If diagnosed and treated appropriately, most fractures heal with minimal deformity and goof hand function can be expected.

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