Hand & Finger Fractures

What Is a Hand or Finger Fracture?

The bones of the hand serve as a framework that supports the muscles controlling wrist and finger movement. Each hand contains five metacarpal bones in the palm and 14 phalanges in the fingers and thumb. When one of these bones breaks, it can prevent you from using your hand, wrist, and fingers effectively. A fracture is the same as a break, though there are different types depending on the pattern and severity of the injury.

Fractures can be stable, with the bone pieces aligned in good position, or unstable, with fragments that have shifted out of place. Some fractures shatter the bone into many pieces, called comminuted fractures. An open or compound fracture occurs when a bone fragment breaks through the skin, which carries a risk of infection and requires urgent treatment.

Symptoms

Symptoms of a broken hand or finger include pain and stiffness, difficulty moving the hand, wrist, or fingers, swelling and bruising, and sometimes visible deformity such as a crooked finger or abnormal angulation. The area around the fracture is usually tender to touch, and you may hear or feel a grinding sensation with movement.

Even if deformity isn't obvious, the inability to make a fist, weakness in grip, or pain with any attempt to use the hand should prompt evaluation. Some fractures, particularly those in the fingers, may cause the finger to cross over an adjacent finger when you try to make a fist, indicating rotational malalignment that needs correction.

Causes & Risk Factors

Hand and finger fractures commonly result from direct trauma such as a fall, crush injury, sports injury, or blow to the hand. Punching a hard object or wall can fracture the metacarpal bones, particularly the bone behind the small finger, sometimes called a boxer's fracture. Fingers can be broken when jammed playing sports, caught in doors, or struck by objects.

Certain activities and occupations place you at higher risk for hand fractures including contact sports, manual labor, and activities involving machinery or heavy equipment. Osteoporosis and other conditions that weaken bones can make fractures more likely even with minor trauma.

Diagnosis

Medical evaluation and x-rays are usually needed to diagnose the fracture and determine the treatment. Your hand surgeon will assess the fracture pattern, whether the bones are aligned, whether the fracture is stable, and whether there are any associated injuries to tendons, ligaments, nerves, or blood vessels. X-rays from multiple angles help visualize the fracture and plan treatment.

Sometimes a CT scan may be ordered if the fracture pattern is complex or involves a joint surface. Your surgeon will also check your ability to move your fingers, assess sensation, and evaluate blood flow to ensure all structures are functioning properly.

Treatment Options

A splint or cast may be used to treat a stable fracture where the bones are well aligned. The splint or cast is typically worn for three to six weeks depending on the location and severity of the fracture and how quickly it heals. During this time, moving the uninjured fingers is crucial to prevent stiffness.

Some unstable fractures where the bone has moved may need to be realigned and then held in place with wires or pins. This can sometimes be done without surgery by manipulating the fracture into position and then inserting pins through the skin. More serious fractures may need surgery to realign the bone and hold the fragments together with pins, plates, or screws.

Sometimes bone may be missing or so severely crushed that it cannot be repaired, requiring a bone graft. In this procedure, bone is taken from another part of your body, from a bone bank, or synthetic bone graft material may be used to fill the gap and support healing.

Surgery: What to Expect

If surgery is needed, it's typically performed as an outpatient procedure under local anesthesia, with sedation available for select cases if needed. The surgery involves making incisions to access the fracture, realigning the bone fragments precisely, and securing them with hardware. The specific approach depends on which bones are broken and the fracture pattern.

After surgery, your hand will be placed in a splint or cast for protection while the bone heals. You'll be encouraged to move your fingers gently as soon as it's safe to do so to prevent stiffness. The hardware used to stabilize the fracture usually remains in place permanently unless it causes problems later.

Recovery

Sometimes a bony lump may appear at the spot of the broken bone during recovery, known as a fracture callus. This is normal and represents healing bone. The lump usually gets smaller over time as the bone remodels. You'll receive a home exercise program with specific exercises to regain motion and strength as the fracture heals. Most people manage their recovery well with home exercises, though hand therapy may be recommended for more complex fractures or if stiffness develops.

It's important to note that not all fractures heal perfectly. Because bones have such a close relationship with ligaments and tendons, the hand may be stiff or weak even after healing. Some fractures may lead to arthritis down the road, particularly if the joint surface was involved. In children, fractures occasionally affect future growth of that bone. Recovery typically takes several weeks to several months depending on the severity of the injury and your adherence to the rehabilitation program.

When to See a Specialist

If you've injured your hand and are experiencing pain, swelling, deformity, or difficulty moving your fingers, seek evaluation promptly. Hand fractures require specialized knowledge to treat properly. Even fractures that seem minor can lead to long-term problems if not treated correctly. Early and appropriate treatment gives you the best chance for full recovery.

Dr. Lackey specializes in treating hand and finger fractures and can determine whether splinting, pinning, or surgery is the right treatment for your specific injury. Proper care now can help you avoid complications and return to your normal activities as quickly as possible.