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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Brief Outline of Femur Fracture

Femur Fracture

It takes tremendous force to fracture the femur due to its strength, as well as the supporting musculature. Football, hockey, and other high impact sports are often associated with femur fractures.

Anatomy and physiology

The femur, also known as the thigh bone, is the heaviest, longest, and strongest bone in the body. Its proximal end has a ball-like head that articulates with the pelvic bone at the acetabulum and forms the hip joint. Distally are the lateral and medial condyles, which articulate with the tibia to form the knee joint. The quadriceps, hamstrings, adductor and abductor muscles surround the femur. The femur is more likely to fracture at the femoral neck, as it is smaller in diameter than the rest of the bone, and is composed of cancellous bone, which has a relatively low density. This would usually involve a hard impact, or excessive landing force from a high fall. The femur may also fracture along the shaft, which is usually caused by tremendous impact from a motor vehicle accident or sheering force across the femur.

Cause of Femur Fracture

Super high impact across the femur, such as a car accident or aggressive tackle in football. High impact directed through the femur such as from landing from a high fall. Direct impact on the upper portion of the hip.

Signs and symptoms

Severe pain. Deformity and possible shortening of leg length. Swelling and discolouration. Inability to move the leg or bear weight.

Complications if left unattended

Permanent disability will result if this injury is left untreated. The large amount of blood loss due to internal injuries to the muscles and arteries could lead to shock and death.

Treatment

Surgery is usually required to fix the fracture.

Rehabilitation and prevention

Femur fractures involve extensive rehabilitation due to the time involved in healing and the musculature involved. The bone will most likely need to be surgically repaired with a plate, rod or pins, which increases the rehabilitation time. Rehabilitation will usually involve a physical therapist working on range of motion and strengthening of the muscles.

Prevention of a femur fracture requires avoiding activities that might result in high impact on the femur. Strengthening the muscles of the quadriceps, hamstrings, adductors, and abductors will also provide extra protection for the femur.

Long-term prognosis

With immediate treatment and repair of the femur along with rehabilitation to strengthen the supporting muscles, there should be no long-term limitations. Full recovery may take up to nine months.

Joint Pain

Brief Outline of Broken (Fractured) Ribs

Contact sports such as football and hockey, or sports that may result in falls or blunt trauma to the chest have a higher incidence of rib fractures than other sports. Extreme sports, horseback riding, and martial arts are other examples of activities that may result in this injury. Pain and tenderness over the rib cage after blunt trauma or a fall, especially with difficulty breathing, should always be treated as potentially broken ribs, and medical help sought.

Anatomy and physiology

There are twelve pairs of ribs, comprising true, false, and floating ribs. The first seven pairs are known as true ribs, and attach by costal cartilage directly to the sternum. The next three pairs are known as the false ribs, and attach to costal cartilage but not directly to the sternum. The final two pairs of ribs are known as floating ribs, and lack attachment either to costal cartilage or to the sternum.

Ribs

The ribs protect the organs inside the chest (thoracic) cavity, and are also essential in the breathing mechanism. The muscles responsible for opening up the chest cavity, to allow air to enter the lungs, attach to the ribs. The ribs are more flexible than many other bones due to their cartilaginous attachments. When the ribs or the cartilage attachments fracture or break, they weaken the support and protection of the chest cavity. This also interferes with the muscles’ ability to open the chest cavity effectively to allow for adequate ventilation, which results in poor air intake and oxygen exchange. Any of the ribs may fracture, and often more than one ribs is involved in the injury.

Cause of Broken Ribs

Hard blow to the chest, side or back. Fall, landing on the chest, back or side. Forceful coughing – most common in people with impaired bone health e.g. osteoporosis.

Signs and symptoms

Pain and tenderness over the fracture site, which may be noted also when pressing on the sternum or compressing the rib cage. Pain and difficulty breathing, especially on inhalation. Depending on the number of ribs involved, irregular movement of the chest during respiration may be noted, as well as some swelling.

Complications if left broken ribs unattended

Fractured ribs that are left unattended will be painful and could lead to infections in the lungs due to shallow breathing. Reduce oxygen levels may result from the lower volume of air taken in. The bone ends may separate and cause damage to the delicate lung tissue underneath, causing a punctured lung or other damage; possibly even to the heart. Overall stability of the chest cavity will be affected also.

Treatment

If a rib fracture is suspected, seek medical attention.

Rehabilitation and prevention

Rest is essential for recovery and repair of fractured ribs. It is important to take at least one deep, lung expanding breath each hour to ensure adequate lung tissue involvement and avoid infections in the lungs. Protecting the injured area until it is completely healed is important. Due to the inability to totally rest this area because of its constant movement during respirations, it takes longer to heal, usually 6-8 weeks. When returning to activity, this area should be padded and protected for an additional week or two.

Building muscle mass in the chest and back will help protect the ribs from injury. Using properly fitting and appropriate protective equipment will help to protect the ribs also. Avoiding trauma to the rib cage is the most important step in preventing rib fractures.

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Brief Outline of Fracture (Collar Bone, Humerus)

Fractures of the shoulder usually involve a break in either the clavicle (collar bone) or the neck of humerus (arm bone), or both. Impact injuries involving a sudden blow to the shoulder or a fall are usually responsible. Contact sports including football and rugby can result in shoulder fractures following a violent collision of two players.

Anatomy and physiology

The clavicle (collar bone) is a slender, doubly curved bone that attaches to the manubrium of the sternum medially (the sternoclavicular joint) and to the acromion of the scapula laterally (the acromioclavicular joint). The clavicle protects the underlying brachial plexus, pleural cap, and great vessels of the upper extremity. Clavicle fractures are common, often resulting from a fall on the lateral shoulder or on an outstretched arm. The humerus (arm bone) is the longest and largest bone of the upper limb. It articulates proximally with the scapula (at the glenoid fossa). Fractures to the humerus are generally the result of a fall on an outstretched arm.

Broken Collarbone

 

Cause of Fracture (Collar Bone, Humerus)

Fall on an outstretched arm. Sudden blow to the clavicle. Collision of two athletes in sports, e.g. football.

Signs and symptoms

Severe pain. Redness and bruising around the site of the injury. Inability to raise the arm.

Complications if left unattended

Complications are uncommon, although pneumothorax, haemothorax, and injuries to the brachial plexus or subclavian vessels are possible, requiring medical intervention. Chronic pain due to osteoarthritis may result should the injury be given insufficient time to heal.

Treatment

  • Immobilisation using an arm sling if the fracture is undisplaced
  • Surgery if the bones are displaced

Rehabilitation and prevention

Bones of the clavicle and humerus must first be realigned following fracture, so that proper healing may ensue. Healing occurs while the clavicle and arm bones are held in place with a strap or sling. After healing, physical therapy, including range of motion and strengthening exercises should be undertaken to restore full movement and flexibility.

Long-term prognosis

Most shoulder fractures are successfully treated without resort to surgery, although this is occasionally required for fractures of the clavicle. For less severe fractures, full recovery and restoration of mobility may be expected. In the case of more severe fractures and particularly in older patients, some loss of motion and possibility of osteoarthritis exist.

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Brief Outline of Wrist and Forearm Fracture

Should an person fall on an outstretched wrist, a break or fracture of the wrist or bones of the forearm may result. Activities vulnerable to such injury include running, cycling, skateboarding, rollerblading and other activities in which an outstretched hand may be used to break a fall.

Anatomy and physiology

The wrist consists of a series of radio-carpal and intercarpal articulations. However, most wrist movement occurs at the radio-carpal joint, an ellipsoid joint. The distal surface of the radius and articular disc articulate with the proximal row of carpals: the scaphoidlunate, and triquestral (triquetrum). Movements are in combination with the intercarpal joints. The intercarpal joints are a series of plane joints, which have articulations between the two carpal row (midcarpal joint), plus articulations between each bone of the proximal carpal row and of the distal carpal row. The distal radio-ulnar joint is immediately adjacent to the radio-carpal joint. A cartilaginous disc separates the distal ulna and radius from the lunate and triquetral bones. Wrist fractures are breaks in one or more of these bones. The two most common wrist fractures are Colles’ fracture, which occurs near the end of the radius, and scaphoid fracture, which involves the scaphoid or navicular, a small bone located on the thumb-side of the wrist that joins the radius.

Wrist Anatomy Bones

 

Cause of Wrist Fracture

  • A fall onto an outstretched wrist.
  • A blow to the wrist.
  • Extreme twisting of the wrist.

Signs and symptoms

Deformity of the wrist. Pain and swelling. Limited motion in the thumb or wrist.

Wrist Fracture

Complications if left unattended

Wrist fractures often fuse naturally, though complications may arise in the untreated fracture leading to limitations of wrist movement and forearm rotation, pronation, and supination. Osteoarthritis may also arise following untreated fractures. Untreated or misdiagnosed scaphoid fractures run the risk of non-union or malunion of fractured bone segments.

Treatment

  • K-Wiring
  • Plates and screws fixation
  • Fibreglass cast

Rehabilitation and prevention

Immobilisation with a rigid cast is generally required for such fractures to properly heal, with x-ray follow-ups to analyse improvement. Where surgery is required, wires or screws may be employed to fuse fractured segments.

Call (+65) 6471 2674 (24 Hour) to fix an appointment with our orthopaedic surgeon regarding wrist and forearm fracture today.