Broken Hand
The bones of the hand serve as a framework that supports the muscles that make the wrist and fingers move. When one of these hand bones is broken (fractured), it can prevent you from using the hand, wrist and fingers.
The hand has multiple levels of bones. The metacarpals provide a framework for the hand at the level of the palm. The phalanges (phalanx bones) refer to the bones that support the fingers and thumb. The thumb has two phalanges (proximal and distal). The fingers have three phalanges (proximal, middle, and distal).
Many people think that a fracture is different from a break, but they are the same (Figure 1). There are different types of fractures, including:
- Stable fracture, when the bone pieces are aligned and are unlikely to move.
- Unstable fracture, when there are bone fragments that have shifted.
- Comminuted fracture, when the bone is shattered into many pieces.
- Open (compound) fracture, when a bone fragment breaks through the skin. This increases the risk of infection.
Causes
A broken hand can occur when enough force is applied to a bone to break it. Bones in the hand can be broken by impact, such as the hand hitting an object, a crush injury to the hand, or a twisting injury to the fingers.
The metacarpals are commonly broken when the hand strikes or hits an object. The metacarpal of the little finger can be broken when the patient punches something. This is why it is commonly called a boxer’s fracture. Aside from the little finger, the other metacarpals can be broken frequently as well.
Crush injuries can result in distal phalanx fractures of the fingers or thumb (broken finger tip). The proximal and middle phalanges can be broken by direct impact, crushing injuries, and twisting injuries. Fractures can also occur from gunshot wounds due to direct impact from the bullet.
Signs and Symptoms
Symptoms of a broken hand following injury may include:
- Pain, stiffness, and swelling
- Difficulty moving the hand, wrist and/or fingers
- Abnormal appearance such as a crooked or twisted finger
Treatment
Medical evaluation and x-rays are needed for your doctor to diagnose the fracture and determine the treatment. Depending on the type of fracture, your hand surgeon may recommend one of several treatment methods.
Many metacarpal and phalanx fractures are stable. Stable fractures can be treated without surgery using splints, casts, or taping of the fingers. When a metacarpal or phalanx fracture causes the finger to be crooked or unstable, surgery to stabilize the fracture is sometimes necessary. In these cases, plates, screws, or pins may be used to hold the broken bone stable while it heals in the correct position (Figure 2).
In severe cases, bone may be missing or be so severely crushed that it cannot be repaired, and a bone graft may be necessary. In this surgery, bone is taken from another part of the body and transferred to the area where bone is missing.
Recovery
Sometimes, a bony lump may appear at the spot of the broken bone during recovery. This lump is made of healing bone and is known as a “fracture callus.” This is normal, and the lump usually gets smaller over time.
Some problems you may have while your fracture is healing include:
- Stiffness
- Shifting of bone
- Infection
- Slow healing
Some hand stiffness should be expected following a broken hand. Your doctor may recommend hand therapy to improve the process. Hand therapy can help treat the stiffness, but sometimes stiffness can be slow to resolve even after the bones heal. Some fractures, especially those around a hand/finger joint may lead to arthritis down the road. Fractures in children occasionally affect future growth of that bone.
© 2024 American Society for Surgery of the Hand
This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.