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Treatment for Hand Fractures

Hand fractures

TREATMENT

Nonsurgical Treatment

If a fracture does not line up in an acceptable position, often, your doctor can realign the bone fragments by gently manipulating them back into position without making an incision. This procedure is called a closed reduction. A cast, splint or brace may be applied to keep the bones in acceptable alignment while they heal. The cast may extend from your fingertips almost to your elbow to support the bones properly.

Your doctor will probably order a second set of x-rays about 1 to 2 weeks later. This is done to ensure that the bones are healing in the proper position.

Depending on the location and stability of the fracture, you may have to wear the cast for 3 to 6 weeks. Some types of fractures can be protected by wearing a removable splint or by being “buddy strapped” to an adjacent non-injured finger. The non-injured finger acts as a “moving splint” to support the injured finger.

Gentle hand exercises can usually begin after 3 weeks.

Surgical Treatment

Some hand fractures require surgery to realign and stabilize the fracture fragments. This includes open fractures in which pieces of bone have broken through the skin.

Your doctor will make an incision to help reposition the bone fragments into their normal alignment. Small metal devices—such as wires, screws, pins, staples, and plates—may be used to hold the pieces of fractured bone in place.

 
Metacarpal fracture and internal fixation

(Left) X-ray shows a metacarpal fracture of the ring finger. (Right) Here, the fracture has been repaired with a plate and screws.

Reproduced from Kozin SH, Thoder JJ, Lieberman G: Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J Am Acad Orthop Surg 2000;8:111-121.

After surgery, you may have to wear a splint or cast for a period of time in order to protect the fracture. If the bone changes position during healing, your finger may lose some function. Your doctor will talk with you about when it is safe to begin range-of-motion exercises and to resume your activities after surgery.

 
Phalanx fractures and internal fixation

(Left) X-ray shows fractures in the phalanges of two fingers. (Right) In this x-ray, the fractures have been repaired with screws.

Reproduced from Kozin SH, Thoder JJ, Lieberman G: Operative Treatment of Metacarpal and Phalangeal Shaft Fractures. J Am Acad Orthop Surg 2000; 8:111-121.

 

Complications of Hand Fractures

Because some fractures require prolonged immobilization in a cast or splint, your hand and fingers may become stiff. Your doctor or, in some cases, an occupational therapist, physical therapist or hand therapist, will provide specific exercises to help decrease stiffness and improve function.

Even after carefully following therapy instructions after fracture treatment, some patients may continue to have difficulty with stiffness or a contracture (loss of motion) in the hand. If this occurs, your doctor may recommend a surgical procedure to help restore motion and/or function to your finger. Commonly used procedures include:

  • Surgical removal of the retained hardware (such as pins, screws, or plate and screws)
  • Tenolysis—freeing up a tendon from scar tissue
  • Contracture release—releasing the tight or restrictive supporting structures around the involved joint, including the ligaments and/or joint capsule

Generally, these procedures are used once a fracture has healed and there is no evidence of progress or improvement in the return of function to the injured finger. Your doctor will talk with you about whether an additional procedure is needed in your situation and how it may affect your recovery. 

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