Hand fractures (Metacarpal and Phalangeal bones)
I have a painful hand after a fall or a punch
Hand and fingers are made of a series of five metacarpal bones in the midhand, two phalangeal bones in the thumb and three phalangeal bones in each of the four fingers. That makes a total of 19 bones that could suffer from a fracture during a trauma.
What are the symptoms of hand fractures?
A painful swelling, deformity or loss of a knuckle are signs of hand fracture which can involve metacarpal or phalangeal bones. There are plenty of joints in between all these bones and fractures are often close to them. Therefore restriction of motion in individual joints close to a fractured hand bone is common.
Who gets a hand fracture?
Fractures of metacarpal and phalangeal bones can happen in simple falls but they are also often the result of punch injuries, i.e pub fight. The finger bones (proximal, middle and distal phalanx) are commonly subject to work related injuries, i.e. crush injury.
How are hand fractures diagnosed?
X-ray is the most common tool to confirm the diagnosis of hand fracture. If there is suspicion of a concomitant soft tissue injury, i.e. tendon, ultrasound can be helpful. In complex cases with multiple fractures or joints being involved CT scan can give a detailed picture.
What is the treatment for hand fractures?
Where hand fractures a simple and undisplaced cast immobilisation for four weeks will suffice. A certain degree of displacement can be tolerated for non operative management as a normal hand function will be restored. However where a fracture is grossly unstable or a joint surface is involved, surgical fixation is recommended.
Surgery for hand fractures
Hand and finger bones are surrounded by tendons, flexor tendons in the palm and extensor tendons at the back of hand and fingers. These are delicate structures inside a sheath that facilitates glide which is required for finger motion. It is therefore a key principal in hand surgery to inclusions at a minimum. Where possible fractures can be stabilised using a configuration of wires that are inserted into to the bone under live radiography via small skin incisions. In other cases open reduction and internal fixation with plate and screws is an option. Fixation has to be stable to allow for early active range of motion exercises in order to prevent scarring of surrounding tendons. Depending on the extent of injury and procedure theses surgeries are carried out as day cases or with one over night stay.
Preparing for surgery for hand fracture
In most cases we will refer you to a hand therapist to manage the swelling and fit a thermoplastic custom brace which will also be required after surgery. If required we will also arrange for a bulk billed pre-admission clinic at the hospital. This is run by a specialist anaesthetist who will gather information and request investigations that are required for safe anaesthesia. Our reception staff will advise of costs, hospital and admission details. Often these surgeries are carried out as emergency surgery and we will endeavour to provide as much information as possible prior to the procedure.
Recovery from surgery for hand fracture
Early range of motion is important following hand surgery in order to limit the development of joint stiffness and tendon scarring. Therefore immobilisation in custom braces will be kept at a minimum and hand therapist will commence immediately with management of swelling and exercises. Most braces will be removable to facilitate this and they can be discontinued four weeks after surgery. Once fracture union is confirmed hand therapy will continue until full function and grip strength have been restored roughly at the ten to 12 week mark.