Fractures

Fractures of the hand and wrist are also common injuries. They may occur as an isolated injury, or associated with other soft tissue injuries. Hand and wrist fractures may be described by a variety of terms such as "closed or open," simple or many pieces ("comminuted"), "articular or extra-articular," "stable or unstable," "displaced or non-displaced," and/or or based upon the fracture's plane configuration ("transverse, oblique, spiral, or segmental"). The following are brief descriptions of various bones in the hand and wrist which are commonly fractured.

  • Distal Radius Fractures.The distal (or lower end) radius is the most common site of fracture in the upper extremity. This is primarily seen in middle-aged and older patients, but it is not uncommon in any age patient. Distal radius fractures usually occur with a fall on an outstretched hand. These fractures may also occur in people who sustain a severe force to the wrist, such as a fall from a height, or motor vehicle accident. Combinations of these fracture patterns are also seen in children, which may involve the growth plate. A variety of fracture patterns may occur, but usually the distal radius compresses and displaces backwards producing the common appearance of a "silver fork deformity." The goal of treatment of distal radius fractures is to realign the displaced fracture and preserve fracture alignment, while minimizing stiffness and swelling. For non-displaced fractures, simple immobilization in a splint or cast may suffice. For more complex or displaced fractures, surgical open reduction and plate fixation is often indicated to most effectively hold the fracture and maximize functional recovery. Often times following surgical open reduction and internal plate fixation, postoperative immobilization can be minimized and patients may return to many activities of daily living sooner with minimal morbidity.
  • Finger fractures. There are three bones in each finger (proximal, middle, and distal phalanges). The most common fracture in the hand involves the proximal phalanx. Most of the time these fractures are non-displaced and heal uneventfully with simple splint protection. Occasionally, a proximal phalanx fracture may be displaced and rotated. If left untreated, displaced proximal phalanx fractures may lead to deformities most noticeable when the finger is flexed – termed as "malrotation." For displaced, unstable fractures, or for those involving joint surfaces, reduction of the joint using anesthesia, employing internal fixation (pins, screws, or plates), are indicated to best insure adequate alignment and minimize potential for development of arthritis.
  • Hook of Hamate Fracture. The Hamate is a carpal bone located on the distal-ulnar side of the wrist. On the volar (palmar) side of the Hamate, there is a beak-like projection of bone called "the Hook of Hamate." Fractures of the Hook of the Hamate may occur when an individual sustains a direct blow to the ulnar palm, commonly after a fall on an outstretched hand, or when an object being held abuts sharply against the palm (such as a golf club, bat, tennis racket). The diagnosis is established based upon the history of injury, physical examination, findings (localized tenderness over the hook), and either confirmed with special radiographic studies, such as a CT scan. Once diagnosed, it is thought that the healing potential is poor with these fractures. Treatment, therefore, usually involves excision of the hook fracture fragment. After surgical excision of the Hook of Hamate, most patients return to all activities without significant residual once the surgical scar has remodeled and becomes non-tender.
  • Scaphoid Fracture. The wrist joint is comprised by the distal end of the radius and ulna, and seven carpal bones. This complex articulation allows for a wide range of motion, including flexion and extension, forearm rotation, and radial and ulnar deviation. The Scaphoid is a peanut-shaped carpal bone, which connects the first and second carpal rows. In young patients, the Scaphoid is commonly fractured when one falls on an outstretched wrist. Most Scaphoid fractures are non-displaced and occur through the mid-aspect of the bone (or waist). Most of these fractures may heal with cast immobilization although this may take several months. Fractures, which occur through the proximal pole, displaced fractures at any site, or in individuals who are not amendable to potentially long-term casting, may be best treated by surgery. This surgery involves placing a small screw completely within the Scaphoid, which compresses and holds the fracture from within until the fracture is healed.
  • Scaphoid Fracture Non-union. Certain fractures of the Scaphoid have a tendency not to heal, especially if it involves the proximal pole, is displaced, or comminuted (broken in many pieces). These are termed as a "non-union." If a Scaphoid fracture does not heal, experience has shown that with time, arthritis of the wrist results because of wear and tear of the cartilaginous surface associated with continued abnormal movement at the Scaphoid fracture. For a Scaphoid non-union, surgical repair is often indicated before arthritis occurs. This surgery usually involves removing fibrous tissue at the non-union site, placing bone graft, and using an internal fixation screw. If there is post-traumatic arthritis associated with a Scaphoid fracture non-union, repair of the fracture is usually not feasible, and other surgical reconstructive procedures are then indicated in an attempt to minimize pain and improve function.

Hand & Wrist Conditions Commonly Treated

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