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Hand 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.

Certain fractures of the wrist bones have a higher rate of complications. A fracture of the scaphoid bone, which is the most common carpal bone fracture, is generally closely monitored and evaluated for fracture type and positioning. Surgery or prolonged immobilization in a cast or splint may be required.

Treatment

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. Some bones in the hand can heal well even if it is not in the perfect position, such as the fifth metacarpal bone. Once the bones have healed, occupational or physical therapy may help restore range of motion, strength, and function.

Operative:

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.