Hand Fracture

What is a hand fracture?

• A hand fracture is a crack or break in one or more of the bones in your hand. The bones in your hand include the phalanges and metacarpals. The phalanges are the bones in your fingers. The metacarpals form your knuckles, and connect your hand to your wrist. When you have a hand fracture, you may not be able to move your hand or fingers like you normally do. Having your hand fracture treated may decrease your symptoms such as pain. Treatment may allow you to return to the activities you enjoy, such as sports.
  
  

What causes a hand fracture?

A direct blow (hit) to your hand may cause one or more bones in your hand to fracture. The following are the most common causes of hand fractures:

• Accidents: Car and sports accidents are common causes of hand fractures. A boxer’s fracture is a fracture caused by a direct blow to your little finger. Boxer's fractures happen when you punch something hard with a closed fist.
  
  
• Fall: Landing on the back of your hand from a fall often leads to a hand fracture.
  
  
• Stress: Stress fractures occur when the muscles attached to bone becomes tired from using them too much. Muscle stress leading to a hand fracture is more common in sports, such as softball and tennis.

What are the different types of hand fractures?

• Non-displaced: A fracture is non-displaced when the bone cracks or breaks but stays in place.
  
  
• Displaced: A fracture is displaced when the two ends of the broken bone are separated.
  
  
• Comminuted: A fracture is comminuted when the bone is broken in many different places.
  
  
• Open fracture: An open fracture occurs when the broken bone breaks through your skin.

What are the signs and symptoms of a hand fracture?

You may have any of the following:

• Deformity (your hand is shaped different then normal). You also may have an abnormal bony bump in your hand.
  
  
• Pain that worsens when moving your hand or wrist.
  
  
• Problems holding, and pain when trying to grab an object.
  
  
• Problems moving your injured hand.
  
  
• Swelling, bruising, or open breaks in the skin of your injured hand.
  
  
• Tenderness (pain when touched) over the injured area.
  
  
• Weakness or numbness (loss of feeling) in your hand.

How is a hand fracture diagnosed?

Your caregiver will check the skin over your injured hand for any open breaks in the skin. He may touch areas of your hand to see if you have decreased feeling. He also may check for problems with your hand movements and grip. You may need any of the following:

• X-rays: X-rays are pictures of your hand to check for broken bones. You may need many x-ray pictures taken of your hand.
  
  
• Bone scan: This is a test to look at your hand bones. You are given a small, safe amount of radioactive dye in an IV. Pictures are then taken of your injured hand. Caregivers can look at the pictures for broken bones.
  
  
• Computed tomography scan: This test is also called a CT scan. A CT scan is an x-ray that uses a computer to take pictures of your hand. You may be given a dye before the pictures are taken to help caregivers see the pictures better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish or have any other allergies.
  
  
• Magnetic resonance imaging scan: This test is also called an MRI. During an MRI, magnetic waves are used to take pictures of your hand. You will need to lie still during an MRI. Never enter an MRI room with any metal objects. This can cause serious injury.

How is a hand fracture treated?

• Brace, cast, or splint: A brace, cast, or splint may be put on your hand to decrease your hand movement. Braces, casts, and splints work to hold the broken bones in place. These devices may help decrease pain, and prevent further damage to your broken bones.
  
  
• Finger strapping: Your caregiver may strap your broken finger to the one next to it. Strapping your broken finger will hold the broken bone in place. Strapping the broken finger to a non-broken finger allows the fingers to move together to decrease stiffness.
  
  
• Medicine: Medicines may be given to help decrease or take away your pain. You also may need antibiotic medicine to prevent or treat an infection by germs called bacteria.
  
  
• Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.
  
  
• Surgery: If you have an open fracture, you may need debridement before your surgery. Debridement is when your caregiver removes damaged and infected tissue, and cleans your wound. Debridement is done to help prevent infection and improve healing.
  
  
  • External fixation: During external fixation, screws may be put through your skin and into your broken bones. The screws will be secured to a device outside of your hand. External fixation will allow your bones to be held together so they can heal. External fixation is often done if you have severe tissue damage, or you have many injuries.
    
    
  • Open reduction and internal fixation: During internal fixation surgery, your caregiver will make an incision (cut) in your hand to straighten your broken bones. He will use screws and a metal plate, nails, or wires to hold your broken bones together. This surgery will allow your broken bones to grow back together.
    
    
  • Percutaneous pin fixation: During percutaneous pin fixation, your caregiver will use metal wire pins to straighten the broken bones in your hand. The pins will hold the broken pieces of bone together. Your caregiver will place the pins through your skin and into your bone using a small drill.
  
  
• Tetanus shot: You may need a tetanus shot if you have breaks in your skin from your injury. A tetanus shot is a shot of medicine to prevent you from getting tetanus. The shot is normally given into your arm. You should have a tetanus shot if you have not had one in the past 5 to 10 years. Your arm can get red, swollen, and sore after getting this shot.

What can I do to help my hand fracture heal?

• Elevate your hand: Keeping your hand above the level of your heart may help decrease pain and swelling. Pillows can be used to keep your hand elevated.
  
  
• Ice: Ice causes blood vessels to constrict (get small) which helps decrease swelling and pain. Put crushed ice in a plastic bag and cover it with a towel. Put the ice pack on your hand for 15 to 20 minutes every hour. Use the ice for as long as your caregiver says you should. Do not sleep with the ice pack on because you can get frostbite.
  
  
• Rest: You may need to rest your hand and avoid activities that cause you pain.

What are the risks of having a hand fracture?

• If you need a brace, cast, or splint, your hand may become very stiff. During surgery, the nerves, tissues, and blood vessels in your hand may be damaged. You may have numbness or weakness in your hand. You may form scar tissue near your surgery site leading to tightness and pain in your hand. After surgery, you may get an infection. You may also get an infection where pins have been placed through your skin. Your hand may not heal, or work as well as it did before your injury. Screws, nails, or pins used during your surgery may come loose, and you may need another surgery.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• Without treatment, your broken hand may not heal. If your fracture heals on its own, your hand may be deformed. You may not be able to move your hand as well as you did before your injury. You may have pain and weakness in your hand. You also may lose feeling in your hand. You may have tissue damage, and you may get an infection. Ask your caregiver if you have any questions or concerns about your hand fracture or treatment.

Where can I find more information?

Contact the following:

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont , IL 60018-4262
  Phone: 1- 847 - 823-7186
  Web Address: http://www.aaos.org/
  

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You have questions or concerns about your injury, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your injured hand or fingers become numb.
  
  
• The pain in your injured hand gets worse.
  
  
• The skin or fingers of your injured hand become swollen, cold, or turn white or blue.
  
  
• You have open skin areas on your hand that will not stop bleeding.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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