Hand Fractures

Metacarpal (bones in the palm) or phalanx (bones in the fingers) fractures are seen regularly in emergency departments and often simply buddy-taped and told “you will be fine in 4 weeks” – it is a myth that all metacarpal and phalanx fractures should be treated in this manner.

Common fractures of the metacarpals are often of their bases, oblique or comminuted (splintered) fractures of the shafts and the metacarpal neck fractures, classically called a “boxer’s fracture” (due to punching mechanism) if of the little finger metacarpal.

Phalangeal fractures are divided up according to their location. The proximal phalanx is P1, the middle P2 and the distal or terminal phalanx P3. Fractures in these locations are again described according to their soft tissue covering (open or closed) and then by morphology, being either transverse, oblique, or comminuted. Acute fractures will have some swelling, bruising and tenderness, and may have an associated degree of deformity, depending on the displacement. In some instances patients present following a “sprain” that doesn’t get better, some time after the event. An Xray is essential to diagnose the fracture, and decide on management, whether non-operative or operative management is indicated.

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  • Management

Metacarpal fractures

Management depends on whether the fracture is open (has a wound over it) or closed, whether it goes into the joint or not, and then on the displacement. If open, it requires a thorough debridement and irrigation to clean it, and then mostly some form of fixation is used, depending on the fracture morphology and location. Open injuries may have associated nerve, vessel, tendon or joint injury.

If closed and within the joint, and there is significant displacement, the patient requires an open reduction and fixation of the joint.

If closed and outside the joint, the management is decided upon according to deformity and displacement.

If non-operative management is required, it involves immobilising the hand in a splint, usually for 3-4 weeks before range of motion exercises can be begun.

Phalangeal fractures

Phalangeal fracture management is similarly determined by whether open or closed, intra or extraarticular (within the joint or outside the joint) and then on the degree of displacement

If open, it is treated with the same principles as for a metacarpal fracture and then mostly with subsequent fixation, either using a wire or screws and a plate if necessary.

If closed and intraarticular, again, it usually requires and open reduction and fixation to restore the joint to normal function.

If closed and extraarticular, the management is decided on by the degree of deformity and displacement.

For non-operative management, the hand and fingers may need to both be splinted, or simply the individual finger splinted, depending on fracture characteristics.

Conditions Managed

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