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Update on the Treatment of Hand Fractures
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Posted on: 11/30/1999
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What do young men and elderly women have in common? Hand fractures involving the tubular bones of the fingers, especially the last phalanx or bone at the tip of the fingers. Whether from sports-related activities, work injuries, car accidents, or falls, hand fractures can cause significant pain and disability.
Not everyone has access to (or needs) a hand specialist. Many patients can be cared for quite well by their primary care physician or a general orthopedic surgeon. That's why two orthopedic surgeons from George Washington University Medical Center put together this review on current treatment strategies for all kinds of fractures of the hand and fingers. It was meant to serve a broad audience of physicians who treat the majority of hand fractures.
An accurate and timely diagnosis is always the first step. With careful review of the patient's history (including the mechanism of injury), physical examination, and good quality X-rays, most hand fractures can be identified and a plan of care developed. The main stumbling block in this process is making sure that all other injuries (especially soft tissue damage of nerves, tendons, and ligaments) are recognized.
Most often, surgery is not needed. Conservative (nonoperative) care consisting of short-term immobilization in a splint or cast. In some cases, a particular position of the hand and wrist is necessary to limit specific motions. And there is a danger of permanent stiffness, pressure sores, and loss of motion with prolonged immobilization. Movement of all uninvolved parts of the upper extremity is important and patients should be advised when and how to keep moving.
The surgeons who authored this article review each of the possible fracture types of the hand and fingers. This includes fractures of the distal phalanx, middle and proximal phalanx, metacarpals, thumb, as well as severe and combined injuries. When surgery is required, descriptions and drawings are provided to guide the surgeon.
Special attention must be paid to intraarticular fractures (fractures that extend into the joint). This type of fracture is often accompanied by damage/rupture of the ligaments needed for joint stability. Complications are to be expected with stiffness being the most common (and most difficult to treat) problem encountered. Infection around pins, screws, and wires used to hold the bones together during healing is another potential problem. The choice of hardware and the amount of skin tension on the wires are risk factors for infection that can be managed by the surgeon.
Fortunately, the hand is versatile, resilient, and forgiving making it possible to treat hand fractures without surgery. But in selected cases, surgery will aid and assist healing and recovery. The details contained within this article will guide physicians and surgeons in making the best treatment decisions for each patient who presents with a hand/finger fracture. Patients can expect that, in time, they can return to normal motion and use of the involved hand.
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References:
Clifton Meals, MD, and Roy Meals, MD. Hand Fractures: A Review of Current Treatment Strategies. In The Journal of Hand Surgery. May 2013. Vol. 38A. No. 5. Pp. 1021-1031.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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