Hand Fracture

What is a Hand Fracture?

A hand fracture is characterised by a break in the bones of the hand. The hand comprises various bones, including the phalanges (small bones of the fingers) and the metacarpals (long bones within the palm). Fractures in these bones can result from incidents such as falls, direct impacts, crush injuries, or sports-related traumas. The approach to managing a hand fracture depends on the specific bone involved, the type of fracture, and the overall health of the individual.

Types of Hand Fractures

Hand fractures can be classified into several types, based on the location and nature of the fracture.

• Phalangeal Fractures
  These involve the phalanges, the small bones of the fingers. Each finger has three phalanges, except for the thumb, which has two.
• Metacarpal Fractures
  These fractures occur in the metacarpals, the long bones in the palm that connect the fingers to the wrist. The fifth metacarpal, supporting the little finger, is prone to fracture. This is often termed a “boxer’s fracture”.
• Intra-articular Fractures
  These fractures involve a joint surface and can affect the movement and function of the hand.
• Comminuted Fractures
  This is when the bone is broken into several pieces, often requiring more complex treatment.

Symptoms

The symptoms of a hand fracture can vary depending on the severity and location of the fracture. It is similar to symptoms of other conditions like carpal tunnel syndrome or trigger finger.

• Swelling and Bruising: The area around the fracture often swells and becomes discoloured due to bruising. This swelling can extend to the surrounding tissues.
• Pain: Pain is typically immediate and can vary from mild to severe, depending on the fracture’s complexity. It intensifies during activities that involve gripping or squeezing and can persist even during rest.
• Visible Deformity: In some cases, the fractured hand may appear visibly misshapen or deformed. This is particularly evident in displaced fractures where the bone fragments have moved out of alignment.
• Reduced Mobility: Movement of the affected fingers or the entire hand may be limited. This includes challenges in performing simple tasks like holding objects or making a fist.
• Tenderness: The area around the fracture is often sensitive to touch and pressure, indicating the precise location of the fracture.
• Numbness or Tingling: If the fracture impacts the nerves within the hand, there may be a sensation of numbness or tingling, particularly in the fingertips.

Causes and Risk Factors

Hand fractures typically result from direct trauma or impact on the hand.

Non-Surgical Treatment Options

Non-surgical treatments are often effective for certain types of hand fractures, particularly those that are not displaced. These treatments focus on facilitating bone healing while minimising pain and preserving hand function.

Splints and Casts

These are custom-fitted to the patient’s hand to ensure proper immobilisation. The type of immobilisation device chosen depends on the fracture’s location; for instance, a cast extending to the elbow may be necessary for a more severe fracture.

Buddy Taping

This technique involves taping the injured finger to an adjacent non-injured finger. It provides support and limits movement, allowing the injured finger to heal while maintaining some range of motion.

Pain Management

Over-the-counter pain relievers like ibuprofen can help manage pain and reduce inflammation. In addition to over-the-counter medications, techniques such as ice application and elevation can help reduce swelling and discomfort.

Hand Therapy

This involves a range of exercises aimed at restoring mobility, strength, and flexibility. The therapist may also use modalities like ultrasound or heat treatment to aid in healing. Early initiation of therapy, typically after a period of immobilisation, can help prevent stiffness and ensure the hand regains full functionality.

Surgical Treatment Options

In cases where non-surgical treatments are insufficient, surgical intervention may be necessary.

• Open Reduction and Internal Fixation (ORIF)
  This procedure involves making an incision to directly access the fracture. The bones are then realigned, and hardware like screws, pins, or plates is used to hold the bone fragments together.
  
• External Fixation
  In some cases, especially with severe crush injuries, external frames may be used to stabilise the hand.
• Bone Grafting
  For fractures with bone loss, bone grafts may be necessary to provide structural support and facilitate healing.
• Tendon Repair
  If the fracture involves damage to the tendons, surgical repair of the tendons might be required.