The skeleton of the hand consists of a series of bones that form its supporting structure (metacarpal and phalanges). This structure serves as a point of attachment to the various tendons that lead to the mobility of the fingers in the joints. A fracture occurs when a sufficient force is applied to the bone to break it, triggering pain, edema and functional disability, often associated with deformation.

Fractures may be simple and aligned and stable, may be unstable with an angular or rotating tendency, and may be comminutive (with multiple bone fragments (usually very unstable). An exposed fracture occurs when one of the bone fragments punctures the skin and lacks special attention for risk of infection.

How is the hand affected

Fractures in the bones of the hand cause pain, swelling, stiffness, and loss of movement and are often associated with rotation and bone deformation that is reflected in finger alignment. The close relationship of bone with ligaments and tendons can lead in some situations to stiffness and loss of strength even after consolidation. Fractures involving the joints can lead to premature arthrosis.

How they are treated

Clinical evaluation and x-ray are required to evaluate the fracture and its treatment. Immobilization with splint or plaster may be indicated for stable and aligned fracture. Some fractures can be reduced and fixed percutaneously with steel wires or screws. Others may require open reduction and fixing with screw or plates. In some cases it may be necessary to use bone graft to complement fracture stabilization. External fixators may be an alternative in multifragmented fractures.

What is the expected result?

Anatomical alignment is not required for good functional outcome. Fractures with good bone alignment can be expected to evolve with a good functional recovery. Problems with fracture healing include stiffness, poor alignment with finger rotation or angulation, infection, delayed healing, or non-healing. Fractures in children can affect bone growth. A physical therapy program with exercise and splinting may be indicated.