The bones of the hand consist of multiple longer bones called a metacarpal and multiple smaller bones of the digits called a phalanx. There are five metacarpal bones located in the hand that connect the wrist bones to the fingers and thumb. Each finger has three separate phalanx bones, and the thumb has two separate phalanx bones. Numerous muscles and tendons attach to these bones which provide our hands the dexterity to perform intricate motions. When fractures of the hand occur, this precise balance of motion can be greatly affected.
Fractures or breaks involving the hand, thumb, and fingers are very common and range from simple stable injuries to complex unstable injuries. The stability of the fracture is typically based on the degree of injury and amount of force that caused the break. When a fracture occurs, symptoms generally include pain, tenderness, swelling, loss of finger motion, and deformity. Most simple fracture patterns typically have no or minimal deformity. When broken bones are unstable, the bone fragments displace or shift out of normal alignment resulting in obvious deformities such as a crooked finger, shortened finger, depressed knuckle, or large bump on the back of the hand. However, an obvious deformity may not always be seen with some complex fractures of the hand, thumb, and fingers. Evaluation by your hand doctor in a timely manner is essential to help avoid possible complications associated with these injuries.
X-rays are needed to indentify the fracture. Depending upon the type of fracture pattern, location of the break, and findings on examination by your hand specialist, several treatment methods may be recommended. Perfect alignment of the bone on x-ray is not always necessary to obtain good function of the hand. A splint or cast may be used for treating fractures that have no displacement, have been realigned by manipulation, or have acceptable alignment despite mild angulation or displacement of the bone fragments. The splint or cast is used to protect the position of the fracture until sufficient healing. Some unstable fractures that are difficult to control may need to be manipulated and then held in place with wires or pins. The pins are then removed after adequate healing of the bone. Other more complex fractures may need surgery to realign the fractured bone through an incision (open reduction) and are then fixed with pins, rods, screws, or metal plates with screws. If the fracture is stabilized or when enough healing of the broken bone has occurred, range of motion exercises for the fingers or thumb may be started to help avoid stiffness. Because of the close relationship of bones to ligaments and tendons, the fingers or thumb can become stiff even after the fractured bone heals. Whether you are treated with or without surgery, your physician may coordinate a therapy program with a Hand Therapist to help improve and quicken the recovery process. Dr. Katz will discuss these various options to help you choose the treatment that is best for you.