Fractures and Dislocations of the Hand

Introduction:

Fractures of the hand are very common. They can occur in the small bones of the fingers, called phalanges or in the long bones making up the hand, called metacarpals. The mechanism of injury can be related to sports, car accidents, twisting injuries, altercations, falls and crush injuries.

Diagnosis:

There is usually swelling, bruising, pain of the involved finger or hand and sometimes deformity causing the finger to have less movement and to overlap with the neighboring finger when attempting to make a tight fist. One of the most common fractures we treat at Central Jersey Hand Surgery is the "Boxer's Fracture" or 5th finger metacarpal neck fracture. This is often sustained after punching a wall or during an altercation. It results in a flat depressed knuckle when attempting to make a fist. An x-ray is usually obtained in the emergency room and the hand stabilized with a splint and the patient referred to our office for evaluation. The skin is examined for lacerations and the digital nerves are tested for any loss of sensation.

Treatment:

Most fractures of the phalanges and metacarpals can be treated non-surgically with a splint or cast. Some fractures are displaced and can be manipulated into better reduction in the office then splinted. The patient usually returns to the office weekly early on, then every 2 weeks afterwards, to obtain an x-ray and make sure the fracture has not shifted. Most fractures go on to healing in 4-6 weeks, followed by physical/occupational therapy if they experience lack of mobility or stiffness.

Some fractures are highly unstable and are not amenable to closed reduction or splinting alone. They require surgical intervention. This can be performed with pins inserted through the skin without making any incision or with plates and screws inserted through a small incision over the affected bone. The surgery can be carried out as same day surgery under conscious sedation with local anesthesia or general anesthesia. This can be performed in one of our three state of the art Ambulatory Surgery Centers located conveniently in proximity to our three offices. After a brief recovery period, the patient is sent home the same day. The pins are usually removed in the office, after the fracture is healed.

Plates and screws can be left in the body permanently unless they cause irritation of the skin or tendons. If that happens, they can be removed after a minimum of 6 months to a year.

At Central Jersey Hand Surgery, we are highly trained to tackle any difficult fracture. We understand how this injury can affect your activities of daily living and can be devastating, resulting in loss of motion, jeopardizing your career and normal use of your limb. We realize how important your hand is and we will design a specific treatment plan individually for you. Our goal is to have every fracture heal with the best anatomic reduction possible so you can return to work, sports and all your normal activities in a timely fashion.

Related Information

carpal tunnel syndrome Pre-op x-ray of a displaced spiral proximal phalanx fracture, which is usually best treated with surgical correction.

carpal tunnel syndrome Post-op x-rays showing anatomic fixation with three screws, a very rigid method to hold the fracture which allows early range of motion.

carpal tunnel syndrome A displaced, mid-shaft fracture of the middle metacarpal.  When displaced, these are best treated with internal fixation.

carpal tunnel syndrome The fracture has been fixated by a plate and screws, a very rigid technique that avoids need for a cast, and allows immediate range of motion.

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