Hand Fractures

Injuries to the hand are very common and they can be as a result of many different activities. A fracture is a break in the bone and can occur in any bone of the hand. 

What should I do if I have injured my hand?
You should:

  • remove any rings or jewellery
  • elevate your hand
  • cover any open wounds
  • attend your minor injuries unit to seek further medical attention

What are the symptoms that I may have broken my hand?
You may have swelling, bruising and/or pain within the hand. This can cause reduced movement and there may be a deformity present.

How is the diagnosis made?
As you are examined, the medical practitioner will assess your injury, looking for any deformity to the hand, or any damage to the tendons and nerves. An X-ray will often be performed to look for any fractures.

What is the treatment?
Treatment is usually initiated in the emergency care centre that you attend. This will usually be in the form of a splint or a plaster cast. If the fingers are injured, then they may be taped to the adjacent uninjured one. Many fractures in the hand can be treated in this way without the need for any surgical operation.

For certain hand fractures, an operation may be recommended. This will be discussed with you and this will be a shared decision with you and your surgeon. The type of surgery is dependent on the nature of the fracture and may involve either pins (K-wires) to stabilise the bones (which often require removal) or a more extensive procedure using plates and screws.
Following surgery, your hand will usually be placed into a plaster cast or splint. You will be referred to the hand physiotherapists to gradually mobilise your hand.

How long will my injury take to heal?
Many factors influence the outcome of fracture healing, but the vast majority of fractures heal without complication and most fractures will heal within 4-6 weeks. 

Does smoking affect fracture healing?
Yes – the chemicals in cigarettes and smoking devices can prolong the time it takes for a fracture to heal, and may even stop healing altogether. We recommend that you stop smoking to allow the fracture to heal.

Can I take painkillers?
We recommend simple pain killers such as paracetamol. However, if you are unable to tolerate them or have any allergies to them, we advise you contact your doctor for an appropriate alternative.

How long do I need to wear a splint for?
We recommend that in the first 1-2 weeks that you wear a splint for comfort, but allowing your fingers to move. In the subsequent weeks, the fracture will be healing and you should avoid using a splint and be gradually increasing your normal daily activities.

Can I use my hand?
Some patients may develop some stiffness and some reduction in movement and strength following their injury so it is vital that you use your hand as your pain will allow. It is important that you keep your fingers bending to prevent any stiffness.

What exercises should I do initially?
Basic finger exercises are intended to let the finger tendons glide and allow the finger joints to move through their maximal range of motion. You should perform each these exercises up to 10 times every hour you are awake.  Do them in the order stated to get the maximum benefit.
Your exercises should be comfortable to do. It is not helpful to push through pain. They should be performed gently and without force.

If you have more pain or swelling in your hand afterwards do fewer exercises the next time. If your joints are stiff you can use the other hand to achieve the position by gently stretching the fingers straight or pushing them to bend. 

After you have done each exercise return to the starting position then try the next exercise.

STARTING POSITION

Begin with your elbow resting on a table. Bring your fingers as straight as possible and pull them together

Make a hook / claw. Keep the base knuckles straight

Make a flat fist. Keep the fingertip joints straight

Make a full fist

Make a beak or glove puppet shape (knuckles bent, fingers straight)

Splay your fingers wide and straight

What are the outcomes following my injury?
Some patients develop some stiffness within their hand which may be associated with loss of movement. This should hopefully resolve with exercises prescribed by the hand physiotherapists. In significant injuries that involve the joints, some patients will develop arthritis in the longer term.

© Fife Hand Service 2020

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