Hand & Wrist Fractures

What are Hand & Wrist Fractures?

Hand and wrist fractures refer to breaks or fractures in the hand and wrist bones. The hand consists of multiple small bones called metacarpals, while the distal ends of the radius and ulna bones form the wrist. Fractures can occur in any of these bones, ranging from simple cracks to complete breaks.

Impact of Hand & Wrist Fractures on Anatomy and Health

The hand is a complex structure comprising bones, joints, tendons, ligaments, and muscles that work together to facilitate fine motor skills and daily activities. Fractures disrupt these structures' normal alignment and functioning, leading to pain, swelling, stiffness, and impaired hand function.

Who is Most at Risk for Hand & Wrist Fractures?

Hand and wrist fractures can affect individuals of all ages, but certain factors can increase the risk. These include:

• Osteoporosis: Weakening of the bones due to osteoporosis can increase the susceptibility to fractures, even with minimal trauma.
• Sports and Activities: Participation in ball-handling sports, such as football or netball, or high-energy activities, such as trail-bike riding,  can increase the risk of fractures.
• Age and Gender: Older adults and postmenopausal women may have a higher risk of wrist fractures due to decreased bone density.

Causes of Hand & Wrist Fractures

Hand and wrist fractures can be caused by various factors, including:

• Falls: Landing on an outstretched hand can result in wrist or hand bone fractures.
• Sports Injuries: High-impact sports or accidents during athletic activities can lead to hand and wrist fractures.
• Motor Vehicle Accidents: The forceful impact during an accident can cause fractures in the hand and wrist.
• Direct Blows: A direct blow to the hand or wrist, such as in a fistfight or while protecting oneself from an object, can result in fractures.
• Repetitive Stress: Overuse or repetitive stress on the hand and wrist, commonly seen in activities like racquet sports, can lead to stress fractures over time.

Symptoms of Hand & Wrist Fractures

The following symptoms may be indicative of hand and wrist fractures:

• Pain, swelling, and tenderness in the affected area
• Visible deformity, such as a misalignment or bone protrusion
• Limited range of motion and difficulty in performing hand or wrist movements
• Bruising or discolouration around the fracture site
• Numbness or tingling sensation in the fingers, indicating potential nerve involvement

Types of Hand & Wrist Fractures

Hand and wrist fractures can involve various bones and have different patterns. Here are some common types of hand and wrist fractures:

• Distal Radius Fracture: Fracture of the radius bone near the wrist joint, often occurring from a fall onto an outstretched hand. It is one of the most common fractures and can result in a Colles' or Smith's fracture pattern.
• Boxer's Fracture: Fracture of the fifth metacarpal bone, typically caused by punching with a clenched fist. It commonly occurs near the neck of the metacarpal bone and is associated with improper punching technique or lack of protection.
• Scaphoid Fracture: Fracture of the scaphoid bone, which is located near the base of the thumb, often results from a fall on an outstretched hand. Scaphoid fractures can be challenging to diagnose and may require further imaging, as they may not always be evident on initial X-rays.
  
• Metacarpal Fractures: Fractures involving the long bones of the hand, which are called metacarpals, can occur in any of the metacarpal bones and may result from various causes, including falls, direct impacts, or crushing injuries.
• Carpal Fractures: Fractures involving the small bones of the wrist, known as carpal bones, can occur in different carpal bones, such as the scaphoid, triquetrum, or hamate bone, and are often associated with high-impact injuries.
• Phalanx Fractures: Fractures of the individual bones in the fingers or thumb, known as phalanges. These fractures can occur in the proximal phalanx (closest to the hand), middle phalanx, or distal phalanx (closest to the fingertip).  The fractures may result from crushing injuries, direct trauma or twisting forces.
• Fractures of the Hook of the Hamate: A specific type of carpal bone fracture involving a hook-like projection on the hamate bone. These fractures can result from direct trauma or repetitive stress on the wrist, such as in sports like golf or baseball.

Stages of Hand & Wrist Fractures

Hand and wrist fractures can be categorised into stages based on severity and healing progress. While the specific stages may vary, they typically include:

• Acute Stage: The initial phase after the fracture, characterised by pain, swelling, and inflammation.
• Healing Stage: When fractured bones start to mend and form a callus.
• Consolidation Stage: The callus strengthens and remodels, gradually restoring bone strength.

Hand & Wrist Fractures Diagnosis

Diagnosing hand and wrist fractures involves a comprehensive evaluation by a doctor. The diagnosis may include:

• Medical History: Discuss the mechanism of injury, symptoms, and relevant medical conditions.
• Physical Examination: Your doctor will assess the affected hand and wrist, checking for deformities, swelling, tenderness, and range of motion.
• X-rays: Imaging studies, such as X-rays, can provide detailed images of the fractures, allowing your doctor to determine the type, location, and severity.
• Additional Tests: In some cases, advanced imaging tests like CT or MRI scans may be necessary to evaluate complex fractures or assess associated soft tissue injuries.

Hand & Wrist Fractures Treatment

The treatment approach for hand and wrist fractures depends on various factors, including the type, location, severity, and stability of the fracture and the patient's age, overall health, and lifestyle.

The primary goals of treatment are to promote proper healing, restore hand and wrist function, alleviate pain, and prevent complications. Here are common treatment options for hand and wrist fractures:

Immobilisation

• Casting or Splinting: Non-displaced or stable fractures may be treated by immobilising the affected hand and wrist with a cast or splint. It helps to align and support the fractured bones, allowing them to heal properly. The cast or splint is typically worn for a few weeks or until the fracture shows signs of healing.

Closed Reduction

• Manual Realignment: A closed reduction may be performed if the fracture is displaced or the bones are not aligned properly. It involves manipulating the fractured bones back into their correct position without surgery. After realignment, the hand and wrist are immobilised with a cast or splint to maintain proper alignment during healing.

Surgical Intervention

• Open Reduction and Internal Fixation (ORIF): In cases of complex fractures, unstable fractures, or fractures that fail to align properly with closed reduction, surgical intervention may be necessary. The procedure involves making an incision to access the fractured bones and using various fixation devices such as screws, plates, wires, or pins to secure the fragments properly.
• External Fixation: An external fixator may be utilised in complex or severely unstable fractures. It involves placing pins or wires into the bone above and below the fracture site, connected to an external frame. The external fixator stabilises the fractured bones externally, allowing for proper healing.

Hand Therapy and Rehabilitation

Once the fracture starts to heal, hand therapy may be recommended to restore hand and wrist function. A hand therapist will design a customised rehabilitation program that includes exercises to improve range of motion, strength, and dexterity. It helps to regain hand and wrist functionality and prevent stiffness or weakness.

Pain Management

• Medications: Over-the-counter or prescription pain medications may be prescribed to manage pain and reduce inflammation during healing.
• Cold and Heat Therapy: Applying cold packs or ice in the early stages helps to reduce swelling and pain. Heat therapy, such as warm compresses or warm water soaks, can be beneficial during the later stages of healing to improve blood flow and alleviate stiffness.

Follow-up Care

Regular follow-up appointments are essential to monitor the healing progress of the fracture and make necessary adjustments to the treatment plan. X-rays may be taken during follow-up visits to assess bone healing.

What if Hand & Wrist Fractures are Untreated?

Leaving hand and wrist fractures untreated can lead to several potential consequences. These may include:

• Chronic Pain: Untreated fractures can result in persistent or worsening pain, affecting daily activities and quality of life.
• Malunion or Nonunion: Improper healing of the fracture can lead to malunion (misalignment) or nonunion (failure to heal), which may require additional interventions or surgeries.
• Reduced Functionality: Untreated fractures can result in limited hand and wrist function, impacting daily tasks, work, and recreational activities.
• Nerve or Blood Vessel Damage: Severe fractures may damage surrounding nerves or blood vessels, leading to long-term complications such as nerve dysfunction or impaired blood flow.
• Development of Arthritis: Improperly healed fractures or fractures involving joint surfaces can increase the risk of developing post-traumatic arthritis in the hand or wrist.