Hand Fracture

A hand fracture is a break in one or more of the bones that make up your hand. These injuries can happen during falls, sports activities, car accidents, or when striking a hard object, and they require proper care to heal correctly and restore full hand function.

Table of contents

• What is a Hand Fracture?
• Anatomy of the Hand
• Common Causes
• Signs and Symptoms
• How Hand Fractures are Diagnosed
• Treatment Options
• Recovery and Rehabilitation
• Risk Factors

What is a Hand Fracture?

A hand fracture means a break or crack in one of the bones in your hand^[1]. Many people think that a fracture is different from a break, but they are the same thing^[13]. These injuries are very common and account for approximately 24,401 cases per year in the UK alone^[14]. Hand fractures are among the most commonly broken bones, with metacarpal fractures (breaks in the palm bones) being especially frequent—one in 10 of all broken bones is a metacarpal fracture^[7].

The fracture can be simple, with only two fragments, or comminuted, meaning the bone breaks into many pieces^[3]. Most hand fractures are closed, meaning the skin remains intact. However, approximately 5% are open fractures, where there is a break in the skin at the fracture site, which increases the risk of infection^[14].

Anatomy of the Hand

Understanding the bones in your hand helps you better understand where a fracture might occur. Each hand contains 27 bones that work together to allow you to move, touch, and grip objects^[7]. These bones are grouped into three main categories:

• Carpals: The small bones that connect your hand to your wrist^[7].
• Metacarpals: The five bones located in the palm of your hand. These bones give your palm its shape and connect your fingers to the hand and wrist^[1].
• Phalanges: The individual bones that make up your fingers and thumb. There are two phalanges in the thumb and three in each of the fingers^[1].

A fracture can occur in the middle of a bone or at the end, near a joint^[1]. 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 typically involves the “neck” of the bone, next to the knuckle joint^[1].

• Metacarpals
• Phalanges
• Carpals
• Fingers
• Thumb
• Palm

Common Causes

Hand fractures happen when enough force is applied to a bone to break it. The most common causes include:

• Falls: Falls are a leading cause of hand fractures, especially when people instinctively reach out their hands to catch themselves^[2]. This protective reflex can lead to a break or crack.
• Sports injuries: Contact sports such as football, hockey, soccer, boxing, and rugby increase the risk of breaking a hand^[7].
• Direct trauma: A broken hand can be caused by a direct blow, such as punching or striking a hard object when your hand is closed in a fist. This is why boxer’s fractures got their name^[1].
• Crush injuries: These can result from accidents at work, when operating machinery, or during motor vehicle crashes^[1].
• Twisting injuries: The bones can break from twisting forces applied to the hand or fingers^[1].

In children, hand fractures commonly result from falls, sports injuries, crush injuries, and various other forms of impact^[5].

Signs and Symptoms

If you have fractured your hand, you will likely experience several telltale signs. The most common symptoms of a hand fracture include:

• Pain: Severe pain that may worsen when gripping, squeezing, or moving your hand or wrist^[2].
• Swelling: The injured area will typically swell soon after the injury^[1].
• Bruising or discoloration: You may notice bruising around the fracture site^[1].
• Tenderness: The area will be tender to the touch^[2].
• Deformity: Obvious deformity, such as a crooked finger or a sunken-in knuckle, especially with boxer’s fractures^[1].
• Difficulty moving: Inability to move the finger, stiffness, or loss of range of motion^[1].
• Shortened finger: The injured finger may appear shorter than usual^[1].
• Scissoring: The injured finger may cross over its neighbor when you make a fist^[1].
• Numbness: Numbness in your hand or fingers may indicate nerve involvement^[2].

If you experience any of these symptoms following an injury, it’s important to see a healthcare professional right away^[2].

How Hand Fractures are Diagnosed

Diagnosing a hand fracture involves several steps to ensure the injury is properly identified and treated.

Medical History and Physical Examination

Your doctor will begin by asking about your symptoms and how the injury occurred. They will perform a careful examination of your fingers and hand, looking for specific signs such as^[1]:

• Swelling or bruising
• Deformity or misalignment of the bone
• Overlapping of your fingers
• Cuts or lacerations to the skin around the fracture
• Numbness or tingling
• Joint stability
• Range of motion

Your doctor will also check the vascular status (blood flow) and nerve function of your hand and fingers to ensure swelling hasn’t affected blood supply^[4].

X-rays

X-rays are the most common and essential imaging test used to detect hand fractures^[4]. They provide a detailed view of the bones, helping doctors pinpoint the exact location and severity of the break. Multiple angles may be necessary to fully assess the fracture. Some hand fractures may not be visible on initial X-rays, so if there is suspicion of a fracture, your doctor may splint the area and ask you to return in one to two weeks for additional X-rays^[4].

Advanced Imaging

For more complex fractures or injuries involving soft tissues, additional imaging may be needed:

• CT scan: CT scans can detect hand fractures that X-rays may miss and provide detailed cross-sectional views. Modern CT technology also offers 3D reconstructions of injuries for enhanced viewing^[4].
• MRI: MRI is best suited to provide information about soft tissue injuries associated with fractures, including damage to tendons, ligaments, and muscles^[4].

Treatment Options

Treatment for a hand fracture depends on the type, location, and severity of the break. In many cases, a hand fracture will heal well with nonsurgical treatment^[1]. However, more serious fractures or those that don’t line up properly may require surgery.

Nonsurgical Treatment

The vast majority of hand fractures respond well to nonsurgical management^[4]. The main goals are to realign the bone if necessary and to immobilize it so it can heal properly.

Reduction: If the broken bone ends aren’t aligned correctly, your doctor may need to move the pieces back into the correct position. This procedure is called a reduction^[9]. Depending on the level of pain and swelling, you may need local or general anesthesia before the procedure.

Immobilization: After reduction, the hand is immobilized using splints, casts, or braces made of fiberglass or plaster. This limits movement in the broken hand and allows the bone to heal^[9]. A cast is typically worn for three to six weeks, depending on the fracture^[4]. Many times, the hand is immobilized in an “intrinsic plus” position, where the proximal finger joint is flexed 90 degrees while the distal joints are held in extension^[4].

It’s important to keep your cast or splint dry and follow all care instructions from your doctor^[17]. You should also keep your hand elevated above heart level as much as possible to reduce swelling^[9].

Surgical Treatment

Hand fractures with displacement, rotation, or those that are unstable generally require surgery^[4]. Surgery aims to restore proper alignment and maintain it while the bone heals. During the procedure, the fracture site is exposed, the bones are realigned, and the fracture is stabilized internally using wires, plates, screws, or intramedullary nails (metal rods inserted inside the bone)^[15].

In severe cases where bone is missing or severely crushed, a bone graft may be necessary. In this procedure, bone is taken from another part of your body and transferred to the area where bone is missing^[13].

Recovery and Rehabilitation

Healing from a hand fracture takes time and dedication. Fractures may take several weeks to months to heal completely^[15]. Even after the removal of a cast or brace, you should limit your activities until the bone becomes solid enough to bear stress.

Early Mobilization and Exercise

Following joint stabilization to allow fractures to unite, early mobilization is needed to maximize functional restoration of the hand^[14]. It’s important to move your fingers regularly as you heal to prevent stiffness. Ask your healthcare professional about the best ways to move them^[9].

If you have a splint or cast, you should wiggle your uninjured fingers often to reduce swelling and stiffness, but do not use that hand to grasp or carry anything^[17].

Hand Therapy

Involvement with a hand therapist is typical for many hand fractures^[4]. A hand therapist can guide the balance between immobilization necessary for fracture healing and motion necessary to limit joint stiffness. After your cast or splint is removed, you may need occupational therapy or hand therapy^[7]. The rehabilitation program involves exercises and a gradual increase in activity levels to strengthen the muscles and improve range of motion^[15].

Expected Outcomes and Potential Complications

Some hand stiffness should be expected following a broken hand. While hand therapy can help treat this stiffness, it can sometimes be slow to resolve even after the bones heal^[13].

During recovery, you may experience a bony lump at the spot of the broken bone. 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^[13].

Some fractures, especially those around a hand or finger joint, may lead to arthritis in the future^[13]. Problems you may encounter during healing include stiffness, shifting of bone, infection, or slow healing^[13].

Pain Management

Some pain is normal after an injury and surgery. Often, the worst of the pain will settle within two weeks^[23]. To manage pain, your healthcare professional may prescribe pain medications or recommend over-the-counter options^[9]. Taking painkillers before bed can help manage nighttime pain, which is commonly worse at night and should settle in the first two weeks^[23].

Keeping your arm elevated above your heart can limit throbbing pain^[23]. Using heat, such as a wheat bag or hot water bottle, can ease pain, but if you are very swollen, ice can help^[23].

Daily Living Adaptations

A broken hand can significantly impact your daily life by causing loss of functionality, difficulty with grasping and gripping, and challenges with personal care^[21]. Keeping your arm clean and dry is important when wearing a splint or if you have a healing wound to limit the risk of infection^[23]. You can purchase a waterproof cover or use a plastic bag taped around your arm during bathing, keeping your hand upright to prevent water from getting inside^[23].

Risk Factors

Anyone can break their hand, but certain factors increase the likelihood of this injury:

• Age: People younger than 40 are at higher risk^[7]. As you age, your bones become weaker, which can also increase your risk of fractures^[8].
• Sports participation: Athletes, especially those who play contact sports like football, hockey, soccer, boxing, or rugby, or practice martial arts, are at higher risk^[7].
• Gender: Men are more likely to experience a boxer’s fracture^[8].
• Bone-weakening conditions: Conditions like osteoporosis (a disease that weakens bones) make bones more susceptible to sudden and unexpected fractures^[7]. Many people don’t know they have osteoporosis until after it causes them to break a bone.
• Previous hand injury: If you have previously injured a specific hand, you are more likely to re-injure it^[8].

It’s important to treat a broken hand right away. If not treated, the bones may not heal correctly, making everyday tasks such as writing or buttoning a shirt difficult. Early treatment also helps lessen pain and stiffness^[2].