Injuries to the hand and fingers are a common occurrence. If the force or impact is enough to break the bones, this should be managed by an orthopedist.
There are 27 bones in the hand. 14 bones make up the finger (phalanges), 5 bones make up the hand (metacarpals), and 8 bones make up the wrist (carpals).
Joints connect these bones. The carpometacarpal (CMC) joint connects the bones of the wrist to the palm. They allow for movement, particularly in the thumb, and are essential for grasping and gripping. The metacarpophalangeal (MCP) joints connect the hand bones to the fingers. These are commonly referred to as the knuckles of the hand. The interphalangeal (IP) joints connect the individual finger joints. They allow you to straighten and bend the finger. Think about all the movement in your joints when you make a fist with your hand.
Fractures can occur when enough force is applied to the bones. Common injuries include:
- Getting hand caught in a door
- Punching an object or person
- Accidents involving power saws or drills
- Falling and catching the fall with hands to the ground
- Jamming a finger while catching a ball
- Car or bicycle accidents
- Gunshot wounds
Types of fractures
There are different characteristics of fractures that help us to determine the severity. Fractures can break in a straight line, in a spiral pattern, broken into multiple pieces, or completely shattered. Fractures that extend into the joint may cause future stiffness, arthritis, and pain. Fractures associated with open wounds increase the risk for infections that may get deep into the bone. Fractures can also be associated with ligament injuries which are soft tissues that cause the bones to bend or straighten.
Non-Operative or Conservative:
If the fracture pattern is overall well-aligned without much deformity, it may heal well without surgery. Splints or casts may position the injury while the bone is healing. Typically, x-rays are performed periodically to assess the positioning and healing of the fracture. Once the bones have healed, occupational or physical therapy may help restore range of motion, strength, and function.
Severe fractures or significant deformities may require surgery to restore the bones to their original position. Fractures that extend into the CMC, CMP, or IP joints are more complex and may warrant surgery to reduce the risk of painful arthritis. Fractures may be associated with tendon or ligament injuries requiring reconstructive surgery to restore function. Devices such as pins, plates, screws, and wires may be used to keep the fracture in the proper alignment while the bones heal. Sometimes, these devices may be removed once the fracture is healed. X-rays are used to evaluate the healing process. In some cases, having surgery may allow for early motion, which helps to prevent stiffness in the hand and fingers.