Fractures of the Hand and Fingers
A fracture is a break in the bone, which occurs when force greater than the bearable limit is applied against a bone. The most common symptoms of any fracture include severe pain, swelling, bruising or bleeding, deformity, discoloration of the skin, and limited mobility of the hand.
The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains, fractures and dislocations, lacerations and amputations while operating machinery, bracing against a fall and sports-related injuries.
Finger fracture
Fingers are fine structures of the human body that assist in daily routine activities through coordinated movements. Any abnormality affecting the fingers can have a huge impact on the quality of life. A finger fracture is not a minor injury, and if left untreated can lead to stiffness, pain, disruption of the alignment of the whole hand and interference with specialized functions such as grasping or manipulating objects. Finger fractures commonly occur during sports activities, when you break a fall or while operating machinery.
Diagnosis & Treatment
The diagnosis of a hand or finger fracture is based on history, physical examinations and X-ray imaging to determine the type and severity of the fracture. X-rays are the most widely used diagnostic tools for the evaluation of fractures. The objective of early fracture management is to control bleeding, provide pain relief, prevent ischemic injury (bone death) and remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after the fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical methods.
Wrist Fracture
The wrist is comprised of two bones in the forearm (the radius and the ulna) and eight other tiny bones. The bones meet to form multiple large and small joints. A wrist fracture refers to a break in one or more bones in the wrist. Wrist fracture can be caused due to a fall on the outstretched arm or an injury due to accidents such as a car accident or workplace injuries. A wrist fracture is more common in people with osteoporosis, a condition marked by brittleness of the bones.
Common symptoms of a wrist fracture include pain, swelling, and deformity at the wrist site, as well as movement constraint in hand and wrist. More commonly, fracture in radius is seen in many fractures exhibiting deformity of the wrist. Deformity may not be apparent in the case of fractures of the smaller bones such as the scaphoid.
Factors such as age, activity level, hand dominance, previous injuries, and arthritis of the wrist besides other medical conditions, and possible predisposing causes in hobbies and occupation of the patient are considered before treating a wrist fracture. Fractures that are not displaced are treated with either a splint or a cast to hold the wrist in place. For displaced fractures surgery may be needed to properly set the bone and hold it in place, sometimes using external devices, with pins, screws, rods, or plates. These implants are placed deep inside through an incision on the lower or upper side of the wrist.
If the wrist fracture is treated externally, pins are fixed above and below the fracture site and these pins are held in place by an external frame outside the body. This keeps the bone stable until healing occurs.
Elbow Fracture
An elbow fracture results from a break or crack in one or more of the bones that make up the elbow joint. There are two types of elbow fractures:
- Extra-articular fractures that include intercondylar fractures, supracondylar fractures, epicondylar fractures, and condyle fractures
- Intra-articular fractures that include trochlea and capitellum fractures, radial head, and proximal ulnar fractures
The elbow is a complex hinge joint formed by the articulation of three bones- humerus, radius, and ulna. The upper arm bone or humerus connects the shoulder to the elbow forming the upper portion of the hinge joint. The lower arm consists of two bones- the radius and the ulna. These bones connect the wrist to the elbow forming the lower portion of the hinge joint. A joint capsule surrounds the elbow joint which contains lubricating fluid called synovial fluid.
The three joints of the elbow are
- Ulnohumeral joint, the junction between the ulna and humerus
- Radiohumeral joint, the junction between the radius and humerus
- Proximal radioulnar joint, the junction between the radius and ulna
Causes:
Elbow fractures can be caused by:
- A direct hit or blow to the elbow joint
- Falling on an outstretched arm
- A twisting injury of the elbow
The differential diagnoses of elbow fracture include sprains, strains, or dislocations.
Treatment:
Treatment varies according to the severity of the fracture and involves the following:
- Rest the elbow until the fracture has healed completely which may take about 8-10 weeks.
- Non-surgical or conservative treatment such as a cast or splint may be used to stabilize the joint if the bones are not displaced. Generally, casts are used to treat fractures in paediatric
- patients as they experience less muscle stiffness compared to adults.
- Your doctor may prescribe pain medications to keep you comfortable, and antibiotics to prevent infection.
- Physical therapy will be recommended by your doctor to increase range of motion and to strengthen your elbow muscles.
- Surgery is considered in cases of displaced bones or unstable fractures, which require realignment and stabilization of the bone fragment.
