Basic Hand Trauma
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1) Hand Fractures
A hand fracture is a break in one of the bones in the hand. This includes:
- The small bones of the fingers (phalanges)
- The long bones within the palm (metacarpals)
A broken hand can be caused by a fall, crush injury, or twisting injury, or through direct contact in sports.
In many cases, a hand fracture will heal well with nonsurgical treatment. Depending on the type and location of the fracture, this may include wearing a cast, splint or buddy straps for a period of time.
The bones in your hand include
- Phalanges. These are the small bones that form the thumb and fingers. There are two phalanges in the thumb and three in each of the fingers.
- Metacarpals. These are the five bones located in the palm of the hand. The metacarpals connect the fingers to the hand and wrist.
The most common hand fracture is a fracture of the fifth metacarpal — the bone in the hand that supports the little finger. This is commonly called a “boxer’s fracture” and involves the “neck” of the bone, next to the knuckle joint. A boxer’s fracture is caused most often by punching or striking a hard object when your hand is closed in a fist. It can also be caused by a fall, motor vehicle accident, or other trauma.
Signs and symptoms of a hand fracture may include:
- Swelling
- Bruising
- Tenderness or pain
- Deformity
- Inability to move the finger
- Shortened finger
- The injured finger crossing over its neighbor (scissoring) when making a fist
In the case of a boxer’s fracture, the patient’s knuckle may look sunken in or depressed. This is caused by the displacement or angulation of the end, or “head,” of the metacarpal bone.
2) Distal Radius Fractures
The radius is one of two forearm bones and is located on the thumb side. The part of the radius connected to the wrist joint is called the distal radius. When the radius breaks near the wrist, it is called a distal radius fracture.
The break usually happens due to falling on an outstretched or flexed hand. It can also happen in a car accident, a bike accident, a skiing accident or another sports activity.
A distal radius fracture can be isolated, which means no other fractures are involved. It can also occur along with a fracture of the distal ulna (the forearm bone on the small finger side). In these cases, the injury is called a distal radius and ulna fracture.
Depending on the angle of the distal radius as it breaks, the fracture is called a Colles or Smith fracture.
- A Colles fracture may result from direct impact to the palm, like if you use your hands to break up a fall and land on the palms. The side view of a wrist after a Colles fracture is sometimes compared to the shape of a fork facing down. There is a distinct “bump” in the wrist similar to the neck of the fork. It happens because the broken end of the distal radius shifts up toward the back of the hand.
- A Smith fractureis the less common of the two. It may result from an impact to the back of the wrist, such as falling on a bent wrist. The end of the distal radius typically shifts down toward the palm side in this type of fracture. This usually makes for a distinct drop in the wrist where the longer part of the radius ends.
- Immediate pain with tenderness when touched
- Bruising and swelling around the wrist
- Deformity — the wrist being in an odd position
Decisions on how to treat a distal radius fracture may depend on many factors, including:
- Fracture displacement (whether the broken bones shifted)
- Comminution (whether there are fractures in multiple places)
- Joint involvement
- Associated ulna fracture and injury to the median nerve
- Whether it is the dominant hand
- Your occupation and activity level
3) Fingers Fractures
A broken finger occurs when one or more of the bones in your finger break. Another name for a broken bone is a bone fracture. People often break their fingers due to injury or weakened bones.
Small bones called phalanges make up your finger structure. Each finger contains three phalanges, while the thumb contains two. Any of these bones can break. Breaks can also happen in your knuckles, the joints where your finger bones come together.
You can relieve pain from a finger fracture for a short time with ice and medication. But you’ll need to see a healthcare provider as soon as possible for an X-ray. Depending on the type and severity of the fracture, your provider may suggest a splint to stabilize your finger or surgery to repair the break.
Finger fractures are the most common sports-related fractures in adults and teenagers in the United States. They sometimes happen along with metacarpal fractures (bones that connect your wrist to your fingers).
Finger fractures often include fractured fingertips and avulsion-type fractures.
Most finger fractures result from injuries. The most common situations that result in broken fingers include:
- Having a fast-moving object, such as a baseball, hit your hand.
- Putting out your hand to break a fall.
- Slamming your finger in a drawer or door.
- Trauma that impacts your finger, such as a car accident.
- Using tools such as drills, power saws or hammers.
People with calcium deficiencies or weakened bones are at higher risk of finger fractures. Fractures are more likely to occur due to:
- Cancer
- Infection
- Lack of calcium (calcium deficiency)
- Malnutrition
- Osteoporosis
If you fracture your finger, pain is likely the first symptom you’ll notice. Your finger may also look oddly shaped or out of alignment. Other broken finger symptoms may include:
- Bruising
- Numbness
- Problems bending your finger
- Redness
- Stiffness
- Swelling
- Tenderness
You may still be able to move your finger even though it’s broken. But moving it will usually cause pain. Sometimes the pain will be dull and not too much for you to bear.
Your provider will also order an X-ray to look for fractures. You may need several X-rays from different angles. Your provider uses an X-ray to:
- Compare your handsYour provider may also X-ray a finger on your uninjured hand to compare how your fingers look.
- Check the fracture’s stabilityThe X-ray shows your provider if the fracture stays in position over time (stable) or has the chance of moving out of alignment again (unstable). This information helps your provider decide on your treatment.
- Look for joint damageX-rays also show injury to your finger joints (cartilage surfaces that connect bones). If your joints don’t line up, you may need surgery to try to correct this.
