hand fractures-orthoinfo - aaos · one of the bones in the ring finger rotated abnormally during...
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This X-ray shows a fracture in the middle ofone of the bones of the finger.
Reproduced with permission from Kozin SH, Thoder JJ,Lieberman G: Operative Treatment of Metacarpal andPhalangeal Shaft Fractures. J Am Acad Orthop Surg2000;8:111-121.
Hand FracturesFractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones(metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.
Symptoms
Signs and symptoms of a broken bone in the handinclude:
Swelling
Tenderness
Deformity
Inability to move the finger
Shortened finger
Finger crosses over its neighbor when makinga partial fist
Depressed knuckle
A depressed knuckle is often seen in a "boxer'sfracture." This is a fracture of the fifth metacarpal, thelong bone below the little finger.
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Diagnosis
A physical examination is done to check the position of the fingers and the condition of the skin. Theexamination may include some range of motion tests and an assessment of feeling in the fingers. This willensure that there is no damage to the nerves. X-rays identify the location and extent of the fracture.
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Treatment
Nonsurgical TreatmentMost of the time, the bones can be realigned by manipulating them without surgery. A cast, splintor fracture-brace is applied to immobilize the bones and hold them in place. The cast willprobably extend from the fingertips down past the wrist almost to the elbow. This ensures thatthe bones remain fixed in place.
A second set of X-rays will probably be needed about a week later. These X-rays are used toensure that the bones have remained in the proper position.
The cast will be worn for three to six weeks. Gentle hand exercises can probably be started afterthree weeks. Afterward, the finger may be slightly shorter, but this should not affect the ability touse the hand and fingers.
Surgical Treatment
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One of the bones in the ring finger rotatedabnormally during the healing process. Whenthe finger is closed over the palm, the fingerrotates but when the fingers are extended, thefinger appears straight.
Reproduced with permission from Kozin SH, Thoder JJ,Lieberman G: Operative Treatment of Metacarpal andPhalangeal Shaft Fractures. J Am Acad Orthop Surg2000;8:111-121.
Metacarpal fracture of ring finger and surgical repair.
Reproduced with permission from Kozin SH, Thoder JJ, Lieberman G:Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J AmAcad Orthop Surg 2000;8:111-121.
Some hand fractures require surgery to stabilize and align the bones. These fractures usuallybreak through the skin or result from a crushing accident. An orthopaedic surgeon can implantwires, screws, or plates in the broken bone to hold the pieces of the fractured bone in place.
Fractures are seen in the phalanges of two fingers(left). The image on the right shows how thefractures are repaired with screws.
Reproduced with permission from Kozin SH, Thoder JJ,Lieberman G: Operative Treatment of Metacarpal andPhalangeal Shaft Fractures. J Am Acad Orthop Surg2000;8:111-121.
If the bone changes position while healing, the finger may lose some function.
After the bone has healed, the surgeon mayremove the implants or may leave them inplace.
The physician may want to examine the handperiodically to ensure that the joint doesn'ttighten (contract) during healing.
Joint stiffness may be experienced becauseof the long immobilization period. Exercisescan help restore strength and range ofmotion. A physical therapist may be able tohelp with this.
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Last reviewed: October 2007
Co-developed with the American Society forSurgery of the Hand
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This informationis provided as an educational service and is not intended to serve as medical advice. Anyone seeking specificorthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your areathrough the AAOS "Find an Orthopaedist" program on this website.
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