MANUAL MINORS
Hand fractures are common injuries that can affect any of the 27 bones forming the hand, including the metacarpals and phalanges. These fractures can result from direct trauma, such as falls, blows, or crush injuries, and may compromise both the structural stability and functionality of the hand. If not treated properly, these fractures can lead to permanent deformities, loss of movement, and weakness in the hand.
Diagnosis
The diagnosis of a hand fracture begins with a detailed clinical history, including the mechanism of injury. Symptoms include localised pain, swelling, tenderness to palpation, visible deformity (in displaced fractures), and limited ability to move the fingers or hand. Physical examination may reveal crepitus or instability at the fracture site.
Confirmation of the diagnosis is made through X-rays in multiple views (anteroposterior, lateral, and oblique) to assess the location, displacement, and angulation of the fracture. In complex cases or intra-articular fractures, a CT scan may be performed to plan surgical treatment.
Differential Diagnosis
Condition | Main Clinical Characteristics | Key Differentiation |
|---|---|---|
Joint dislocation | Deformity, intense pain, loss of motion | No bone fracture on X-rays |
Ligament injury | Pain and joint instability | No fracture or visible bone deformity |
Contusion or sprain | Pain and swelling without deformity | Normal X-rays, no evidence of fracture |
Infection or cellulitis | Swelling, erythema, diffuse pain | No significant trauma history, signs of infection |
Occult fracture | Persistent pain without visible fracture | Lesion not evident on initial X-rays; may require CT or MRI |
Emergency Management
Initial management of a hand fracture includes immobilisation to prevent further displacement of the fractured bones and reduce pain. This can be done using a volar splint or a splint in a functional position, depending on the type of fracture. Applying ice, elevating the hand, and administering analgesics are initial steps to control pain and swelling.
A neurological and vascular assessment is crucial to rule out concurrent injuries to nerves or blood vessels, especially in severe or open fractures. If open wounds are associated with the fracture, antibiotic prophylaxis should be administered, and tetanus vaccination updated.
Displaced, open, unstable, or joint-involving fractures require urgent evaluation by a hand surgeon for planning closed or open reduction with internal fixation.
Definitive Treatment
Definitive treatment depends on the severity and type of fracture:
Non-displaced or stable fractures: These are generally managed with immobilisation using a cast or splint for 4 to 6 weeks. Phalangeal and metacarpal fractures without displacement can be treated conservatively, with radiographic follow-up to ensure proper bone healing.
Displaced or unstable fractures: These require closed or open reduction with internal fixation, using plates, screws, pins, or Kirschner wires to realign the bones and maintain stability. Intra-articular fractures or those affecting the hand’s axis also typically require surgery to prevent deformities and restore function.
Open fractures: These need urgent surgical intervention, including wound cleaning and debridement, along with bone stabilisation using surgical techniques.
After treatment, rehabilitation with physiotherapy is crucial to regain mobility, strength, and hand function. This includes range-of-motion exercises, strengthening, and preventing joint stiffness. Recovery time varies, but close follow-up is essential to avoid complications such as stiffness, arthritis, or malunion (healing in the wrong position).
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