Fractures

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The wrists and hands are important for many day-to-day activities and a fracture can be debilitating.

The wrist is made up of eight small bones which join to the two bones of the forearm – the radius and the ulna. It is most commonly the radius that fractures when you break your wrist. A hand fracture is a break in one of the bones of the hand, including the small bones of the fingers (the phalanges) and the longer bones of the palm (the metacarpals).

Overview

Fractures normally occur due to excessive force or impact on the bone. Falling and landing on an outstretched hand is a common cause of fractures. There are two main types of hand and wrist fractures:

  • Displaced fractures are those where the two ends of the broken bone have moved and are no longer correctly aligned.
  • Non-displaced fractures are those where the broken bones are still correctly aligned.

Fractures can vary in severity. Comminuted fractures are those where the bone shatters. Fractures can also extend into the joint surface and are called Intra-articular. These often require surgery to restore alignment between the bones. Open fractures are where the skin is broken, leading to an increased risk of infection in the bone. These will normally require urgent medical attention to minimise the risk of infection.

Causes of hand and wrist fractures

Fractures can occur when there is a direct impact to the hand or wrist, for example as the result of a trip or fall, particularly if the wrist is twisted at an awkward angle. They are normally the result of trips and falls, car or motorbike accidents or sporting injuries.

Symptoms of hand and wrist fractures

The symptoms can vary depending on which bone or bones are fractured and how severe the fracture is. Common symptoms include:

  • Pain which may be severe.
  • Bruising, swelling and tenderness.
  • Visible deformity of the wrist or hand.
  • Pain when you try to use your fingers. You may also experience tingling or numbness in the fingertips.
  • Bleeding if you have an open fracture.

Diagnosis of hand and wrist fractures

Your doctor will normally take a history from you and perform an examination. If the doctor suspects a fracture you will be referred for an X-ray to confirm the diagnosis and you may also need an MRI or CT scan to get a picture of the fracture fragments or to ascertain if there are any other injuries, for example to the ligaments, tendons, muscles and nerves.

Treatment of hand and wrist fractures

Treatment will vary depending on multiple factors – how the fracture occurred, characteristics of the fracture and also patient factors.

Fractures often need to be immobilised while the bones heal to ensure they are correctly aligned. You may need to wear a cast or splint on your hand or wrist for a time to relieve pain and keep the bones in the correct alignment. The time in cast depends on the type of fracture – some fractures don’t need any immobilisation.

The speed at which the bone heals will be affected by a number of different factors including your age and general state of health. You may need to take pain relieving medication and/or anti-inflammatories to manage the pain, particularly in the early stages.

Hand Therapy is frequently recommended to support rehabilitation, with exercises to improve strength and flexibility in the affected area once the bones have healed.

Certain fracture types or open fractures may require surgery. Bones are held in place with metal plates, pins or screws while they heal. If there is a gap in the bone when it has been realigned, you may need a bone graft to help the bones to heal.

Severe fractures that go into the joint can lead to arthritis of the joint and you may need additional treatment or surgery at a later date.

Consultants

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