WHAT IS A FRACTURE?
The hand skeleton is made up of many bones that form its supporting framework. This frame acts as a point of attachment for the muscles that make the wrist and fingers move. A fracture occurs when force is applied to a bone that is enough to break it. When this happens, there is pain, swelling, and decreased use of the injured part. Many people think that a fracture is different from a break, but they are the same (Figure 1). Fractures may be simple with the bone pieces aligned and stable. Other fractures are unstable and the bone tends to displace or shift. Comminuted fractures (shattered bone) usually occur from a high energy force and are often unstable. An open (compound) fracture occurs when a bone fragment breaks through the skin. There is some risk of infection with compound fractures.
Fractures (or breaks) often take place in the hand. A fracture can cause pain, stiffness, and loss of movement. Because of the close relationship of bones to ligaments and tendons, the hand may be stiff and weak after the fracture heals. Fractures that involve joint surfaces may lead to early arthritis in those involved joints.
HOW ARE THEY TREATED?
Medical evaluation and X-rays are usually needed so that your doctor can tell if there is a fracture and to help decide treatment. Depending upon the type of fracture to your hand, your hand surgeon may recommend one of several methods of treatment.
A splint or cast may be used to treat a fracture that is not displaced, or to protect a fracture that has been set. Some displaced fractures may be held in place with wires or pins without making an incision. This is called closed reduction and internal fixation.
Other fractures may need surgery to set the bone. Once the bone fragments are set, they are held together with pins, plates, or screws (Figure 2). Occasionally bone may be missing or be so crushed that it cannot be repaired. In such cases, a bone graft may be necessary. In this procedure, bone is taken from another part of the body to help provide more stability.
Fractures that have been set may be held in place by an “external fixator,” a set of metal bars outside the body attached to pins which are fixed to the bone above and below the fracture site until the break heals.
WHAT KIND OF RESULTS CAN I EXPECT?
Perfect alignment of the bone on X-ray is not always necessary to get good function. A bony lump may appear at the fracture site as the bone heals and is known as fracture callus. This functions as a “spot weld.” This is a normal healing process and the lump usually gets smaller over time. Problems with fracture healing include stiffness, shift in position, infection, slow healing, or complete failure to heal. Smoking has been shown to slow fracture healing. Fractures in children occasionally affect future growth of that bone. You can lessen the chances of complication by carefully following your hand surgeon’s advice during the healing process and before returning to work or sports activities. A hand therapy program with splints and exercises may be recommended by your physician to speed and improve the recovery process.