Fractures of Hand/Wrist

What is it: Fractures of the hand can occur in either the small bones of the fingers (phalanges) or the long bones (metacarpals). They can result from a twisting injury, a fall, a crush injury, or direct contact in sports.

Scaphoid Fracture Statistics: Most Common Carpal Fracture (60%) – 11% of all hand fractures. Young Active Males: ages 15-35. Fracture of the metacarpals and phalanges comprises approximately 10% of all fractures. Metacarpal fractures account for 30-40% of all hand fractures; fractures of the first and fifth metacarpals are the most frequent. Fractures of the fifth metacarpal neck (boxer fractures) alone account for 10% of all fractures of the hand.

Important Facts: Boxer’s fracture refers to a fracture (break) of the 5th metacarpal that is the hand bone connected to the small finger. It often happens from punching a solid object, hence its name. This injury leads to pain and swelling over the broken bone.

The vast majority of boxer’s fractures can be treated without surgery.

Some fractures will do better with a ‘closed reduction’, where the fracture is ‘set’.

Treatment Duration: Most of the time, the bones can be realigned by manipulating them without surgery. A cast, splint or fracture-brace is applied to immobilize the bones and hold them in place. The cast will probably extend from the fingertips down past the wrist almost to the elbow. This ensures that the bones remain fixed in place.

A second set of X-rays will probably be needed about a week later. These X-rays are used to ensure that the bones have remained in the proper position.

The cast will be worn for three to six weeks. Gentle hand exercises can probably be started after three weeks. Afterward, the finger may be slightly shorter, but this should not affect the ability to use the hand and fingers.

Do’s/Don’ts: First, keep your arm elevated. If your arm is below the level of your heart, it will hurt more. Keep it up, at shoulder level or higher. Prop it up with a pillow when you are sitting or lying down, hold it up when you are standing. Don’t use a sling, as this puts your arm below the level of your heart.

Don’t pick at the cast padding. It will pull out from inside the splint or cast and then it will not be adequately padded.

Common Myths: MYTH: “If you can move it, it can’t be broken.” Only an x-ray can detect a fracture, so don’t delay!

Consult a Physician if a joint is swollen, painful, unusually mobile, and unstable or won’t move normally.

Fractures inside a joint often require surgery and can have very poor results with irreversible complications if treatment is delayed.