The hand contains numerous bones which are essential to its function. The hands are also often injured, as they are frequently our first point of contact with the environment, and are not well protected by soft tissues.
The bones of the hands include the metacarpal bones and the phalanges or finger bones. Except for the thumb, each digit has 3 bones, while the thumb has 2. Each digit is attached to the wrist by the metacarpal bones.
How do hand fractures occur?
Hand fractures can occur either due to direct forces applied to them or indirectly. An example of a direct force causing a hand fracture is when a hand is struck by an object such as a hammer. Should a fracture occur, it will occur at the spot struck by the hammer.
Another way by which a fracture occurs is when a force is applied to the bone at a site distant from the site of the fracture. This is known as an indirect force. This is less common than the direct mechanism.
What are the symptoms and signs of a hand fracture?
After an injury to the hand, patients with hand fractures will complain of severe pain and swelling over the fracture site. There may also be a change in the orientation of the finger, and the patient frequently finds it difficult to move the finger.
In severe cases, there may be broken skin over the finger, and bleeding from the wounds. Patients may also complain of numbness of the injured digit, and the digit may appear pale and cold.
In all cases of hand injuries where you suspect that you might have a fracture, it is recommended that you seek medical help early.
You will first be interviewed by the doctor, who will ask about how the injury was sustained. He/she will also ask about your symptoms and may ask relevant functional questions about your handedness and occupational requirements.
The doctor will then perform a focused examination on your hand, which will include an assessment of the underlying bones and ligaments, and of the skin overlying the site of injury. The nerves and blood vessels in the vicinity will also be assessed for potential injury.
You will then be asked to go for plain X-rays of the hands, which will usually be enough to diagnose any fractures. In severe injuries, or if there is any clinical uncertainty, a computerised tomography scan (CT scan) may also be offered.
Bone alignment in the hand is critical for optimal function. As a result, there is usually a low threshold for recommending surgery to treat hand fractures. In cases where the displacement of the fractured bones is considered minimal, non-surgical treatment may be appropriate.
Non-surgical treatment comprises the use of splints to immobilise the fractured bones in a good position, as to allow for the bones to heal properly. These splints are usually removable for hand hygiene, but frequently have to be worn for 3 to 4 weeks.
In addition to splinting, your doctor may also recommend intermittent exercises for the hands, to keep the joints supple. These are usually guided by a qualified hand therapist.
Surgical treatment of hand fractures depends on the configuration of the fracture and can include modalities such as,
Open reduction of the fracture, where the skin is incised and bones placed in a good position, followed by fixation with either plates or wires
After surgery, patients may be required to wear a splint for a short period of time. Sutures placed will usually be removed in 1 to 2 weeks. In certain patients, removal of implants may be necessary. This is usually performed 6 to 12 weeks after the initial surgery
Regardless of the method used to treat the fracture, patients are generally expected to undergo a course of curated hand therapy. This will allow the joints in the hand to remain supple, and aid subsequent hand function. Therapy for hand fractures may take up to 6 months to complete.
For an assessment of your condition, please book an appointment with Dr. Yong Ren.
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