Fractures of the bones in the hand are often the result of falls, crush, or sports-related injuries. Hand fractures may involve the phalanges of the digits, the long metacarpal bones of the mid-hand, or the carpal bones of the wrist (ex scaphoid, lunate). A hand fracture is the same as a break in the bone. Common symptoms of a hand fracture include pain, swelling, bruising, deformity, and difficulty with movement. Evaluation of a potential hand fracture includes a detailed physical examination and x-rays to visualize the location and severity of the fracture. Additional studies such as a CT scan or MRI scan may be required in complex cases if the fracture is difficult to visualize on plain x-rays, or if there is concern for associated ligamentous injury. Hand fractures are classified as displaced or non-displaced, comminuted (multiple fragments) or simple, extra-articular or involving a joint surface. Fractures are considered "open" if there is a break in the skin overlying the fracture. Many simple hand fractures that are not displaced can be treated with manipulation for realignment without surgery, followed by casting or splinting for a number of weeks to allow healing. Follow-up x-rays at each of your return clinic visits will be taken to ensure that the bone is healing in a good position.
Hand fractures that are displaced or unstable may require surgery to align and stabilize the bone to ensure proper healing and preserve hand function. Surgery may involve a regional, or general anesthetic depending on the location and complexity of the injury. Some fractures can be reduced and stabilized in the operating room without and incisions with wires or pins placed through the skin, called closed reduction and percutaneous fracture fixation. Alternatively, a fracture may require an incision for manipulation and stabilization of the fracture fragments with wires, screws, or plates, known as an open reduction, internal fixation (O.R.I.F.). If a portion of bone is missing or badly damaged, and bone graft may be taken form another part of the body to fill the gap at the time of repair. Post-operative management will require splint or cast immobilization for a number of weeks, followed by a gradual return to activities. Sometimes implants will need to be removed once the bone is healed during a second operation. Many patients have post-operative joint stiffness, and will benefit from work with an occupational therapist to regain function. Some hand fractures fail to heal (nonunion) or heal in an unfavorable position (malunion), and may require specialized surgery to promote healing or correct a deformity. Complex fractures that involve a joint surface can lead to painful post-traumatic arthritis that may require joint replacement (arthroplasty) or joint fusion (arthrodesis). The hand surgeons at the University of Washington Hand Center have extensive experience in the management of these difficult hand fracture cases.