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The hand and wrist are comprised of a number of small bones and joints that are finely balanced by the surrounding tendons and ligaments. Fractures of the wrist and hand can cause significant problems with hand function if they are not properly managed.
Hand and wrist bones that are frequently fractured include the distal radius, the scaphoid, the metacarpals and the phalanges.
The distal radius is the bone at the end of the forearm that joins to the carpal bones of the wrist. It is one of the most common bones in the wrist to be broken. In most cases, distal radius fractures can be managed in a cast or a splint. However, distal radius fixation may be required if the joint surface has been damaged, or the bone ends are significantly out of position.
The scaphoid is one of the carpal bones at the base of the palm. It is a very important bone because it forms joints with five other bones around it. The bone has a complicated shape and its blood supply is fragile. Fractures of the scaphoid can be hard to identify on standard X-rays. If the broken ends of the scaphoid are not properly aligned or the blood supply to the bone is damaged, the bone may heal in an abnormal position (malunion) or it may not heal at all (nonunion). This can lead to significant problems later on such as pain, loss of wrist motion and wrist arthritis.
The metacarpals are the long, tubular bones in the palm. Metacarpal fractures are usually the result of a fall onto the hand or a punching type injury. Most metacarpal fractures do not need surgery. However, if the broken bone ends become twisted, this can cause problems with the fingers not moving properly, such as when making a fist. In these cases, fracture fixation surgery may be required.
The phalanges are the small bones that form the fingers. Phalangeal fractures are often the result of a twisting injury to the finger. They can also occur following a direct blow, such as being struck by a ball.
If the broken ends of the bone become rotated on each other this can cause the finger to become twisted. This then leads to problems with the fingers not moving properly, such as when making a fist.
If one of the finger tendons is attached to a broken end this can also lead to issues with tendon function, such as a ‘mallet finger’.
A number of hand and wrist fractures can be successfully managed with a combination of splinting and mobilisation. Fractures that require fixation surgery will also require splinting and careful mobilisation following the procedure.
At the Melbourne Shoulder and Elbow Centre, we work in conjunction with your hand therapist to make sure your rehabilitation program is optimised to manage your specific injury.
