Module 7 - Hand Injuries

Fractures/ Dislocations

The care of hand fractures must be individualized based on the features of the particular fracture as well as patient-related factors. The fracture should be described initially by its location. The fingers are named (i.e. thumb, index. middle, ring, little fingers) and the particular bone fracture is named (proximal, middle, distal phalanx, metacarpal) and the fracture is described as being on the dominant or non-dominant hand. As well, the fracture should be described according to its displacement, angulation, involvement of articular surfaces (e.g. intra-articular), whether the fracture is open or closed (e.g. compound fracture), communication, type of fracture (oblique, transverse, spiral).

Generally, most hand fractures are treated in a conservative fashion. Stable fractures with slight displacement are reduced under local anesthesia or hematoma block. Undisplaced fractures are splinted. Certain indications for operative intervention exist: displaced intra-articular fractures, unstable angulated fractures, multiple fractures, fractures associated with soft-tissue loss or other soft tissue injuries. The methods for operative fixation of fractures include Kirschner wires (K-wires), interosseous wiring, lag screws, plate and screws, tension band wiring.  The duration of immobilization after hand fractures is usually three to four weeks but some exceptions exist. There is an old saying in hand surgery that for every one non-union, there are a thousand stiff fingers. Immobilization is minimized to improve motion after hand fractures.

Author: Dr. SF Morris