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Fractures of the hand can occur as a result of a twisting injury, a fall, a crush injury, or direct contact in sports. It can occur in the small bones of the fingers (phalanges) or the long bones (metacarpals).
Following a fracture there is usually;
- short finger with deformity
- Inability to move the finger
- Finger crossing over other fingers its when making a partial fist
- Less prominent or obvious knuckle
A clinical examination usually detects the site of the injury. This includes assessment of all the skin, bones, nerves and tendons in the hand. An X-ray is required to identify the location and extent of the fracture. If there is a break in the skin with bleeding it indicates a more severe injury and urgent medical review is required.
Most of the time, the bones can be realigned by manipulating them under local anaesthetic without surgery. There may be cast, splint or fracture-brace application to immobilise the bones and hold them in place. The cast may extend from the fingertips down past the wrist almost to the elbow to stabilise the fracture.
A second set of X-rays at one week later will be arranged in the clinic to ensure that the bones have remained in the proper position.
The cast will be worn for three to six weeks depending on the bone that is fractured. Gentle hand exercises can be started after three weeks in most cases. There may be a slight shortening of the finger when everything has healed, but this should not affect the ability to use the hand and fingers.
Some displaced hand fractures require surgery to stabilise and align the bones. These fractures usually break through the skin and are as a result of a crushing or forceful accident. Wires, screws, or plates may be inserted during surgery into the broken bone to hold the pieces of the fractured bone in place.
If the bone changes position while healing, the finger may lose some function.
After the bone has healed the wires may need to be removed. Plates and screws are not usually removed unless they cause problems with the tendons.
Follow up appointments during recovery period will be made to assess the recovery and detect any complications such as joint tightness (from long immobilisation or lack of exercise) and tendon irritations.
Exercises can help restore strength and range of motion and regular hand therapy appointments will be arranged to help with this.