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Hand Fractures

Hand Fractures (metacarpals & phalanges)

The bones from the wrist joint to the finger- and thumb-tips are known as metacarpals and phalanges. The five metacarpal bones are in the palm of the hand and connect the wrist to the fingers. The 14 phalanges are the bones of the finger and thumb; three for each finger and two for the thumb.These nineteen bones are susceptible to many different kinds of fracture resulting from trauma to the hand. Here is a brief overview of the most common fractures and what we can do to treat them.

Metacarpal fracture (broken hand)

It is quite common to break the metacarpal bones. They account for roughly one-tenth of all fractures, and between 30-40% of all fractures involving the hand. Falls, accidents and punching injuries are common causes. It may not be a surprise to learn the most commonly broken metacarpals are those at the edge of the hand: those that belong to the thumb (1st metacarpal) and the little finger (5th metacarpal). Similarly, they are more likely to break at the ends of the bone than in the middle. Sometimes more than one metacarpal is broken.The symptoms of a fracture are pain, swelling, soreness and difficulty with movement. It may also be noticeable that part of the hand looks misshapen. Treatment for metacarpal fractures varies depending on which parts of the bones are broken.

Treatment for metacarpal fractures

5th metacarpal fractureis common enough for it to have a popular nickname: The Boxer's Fracture. It's usually possible to treat these injuries without manipulation or surgery, by resting the hand and wearing a splint for protection, and resuming careful movement of the hand within 2-3 weeks. It may be that despite full healing there is a change of shape to the knuckles when making a fist, but there should be no loss of function. It is important to get this checked out early to prevent permanent deformity.

1st metacarpal fracture, at the base of the thumb, is known to doctors as a Bennett's fracture. Usually an operation is required, as there may be displacement of the fracture fragments; it is important that the joint heals with an even surface to diminish the risk of arthritis occurring, so the surgeon may choose to hold the fracture in position with a fixture known as a K-wire (or less commonly with screws and/or a plate). Recovery from this procedure involves wearing a cast or splint for up to 8 weeks, with any sutures removed after around 4 weeks.

4th and 5th metacarpal fracture/dislocationis also known as a Reverse Bennett's fracture, and also usually requires surgery to protect the future function of the joints by holding the bones in the correct position. Again, the healing process may take up to 8 weeks with any fixtures removed at the appropriate point.

One common factor for injuries resulting from punching and fighting is that if the fracture is accompanied by a break in the skin, usually caused by contact with a tooth, there is a risk of infection and there may also be damage to the tendon and joint. Surgery is almost always necessary for these injuries and may be accompanied by antibiotic treatment.

Phalangeal fracture (broken finger or thumb)

The fourteen phalanges (phalanx bones) that make up the fingers and thumb are susceptible to injuries from crushing, twisting and sudden impacts. Fractures are usually accompanied by pain and swelling in the finger. The treatment depends on the nature of the break and which bones are affected.

Treatment for phalangeal fractures

Many fractures can be treated without an operation, usually by protecting the finger with a splint for 2-8 weeks depending on the location and severity of the injury. However, it may be necessary in some cases to operate on your finger. As with metacarpal fractures, if the skin is broken this will need to be cleaned thoroughly during surgery to prevent infection. It may be necessary to use a wire to keep the fracture in place for 3-4 weeks to allow the bone to heal in the correct shape.