Broken bones in the hand and wrist are typically caused by trauma from falls, sport injuries, motor vehicle accidents, or direct blows. Hand and wrist fractures may also be a result of repetitive overuse. Prompt assessment and management with an orthopaedic hand and wrist surgeon are crucial for avoiding long-term complications that can cause pain, stiffness, and limited use of your hand.
Your hand and wrist are made up of 27 small bones, supported by ligaments and tendons, and surrounded by muscles, nerves, and blood vessels. A fracture is any break in a bone – the type of break may be a hairline crack or a complete displacement, where the bone has broken into two pieces and become misaligned.
Hand and wrist fractures are often identified by the bone involved. The most common fractures of the hand and wrist involve the distal radius, scaphoid, metacarpals, or phalanges.
A distal radius fracture is commonly referred to as a broken wrist. The radius is one of two bones in your forearm; when a break occurs near the wrist-end of the bone, this is known as a distal radius fracture.
The most common cause of a distal radius fracture is known as a FOOSH – fall onto an outstretched hand – but distal radius fractures may be caused by a variety of other events, including motor vehicle accidents or falling onto your arm from a height. People with fragile bones from osteoporosis are at a higher risk of a distal radius fracture from a minor accident, such as slipping from a standing position.
Symptoms of a distal radius fracture can include:
The scaphoid is one of the eight carpal bones in the wrist. These small carpal bones form the bridge from the long forearm bones to the long, tubular bones in your palm. The scaphoid is integral to optimal motion and stability of the wrist joint, but is particularly susceptible to complications from a break due to its poor blood supply.
Scaphoid fractures are most commonly caused by a FOOSH, but can also be a result of motor vehicle accidents, sport injuries, or any other traumatic impact to the wrist.
Symptoms of a scaphoid fracture can include:
The pain associated with a scaphoid fracture is not always particularly severe, and can sometimes be mistaken for a simple wrist sprain. Due to the irregular shape of the scaphoid bone, a fracture may not show up well on an X-ray. Wrist pain that persists for more than a day should be checked by a doctor as timely treatment can help to prevent complications such as prolonged wrist pain, wrist arthritis, or the bones healing out of position (known as malunion).
The metacarpals are a set of five long bones in the palm of your hand, connecting the finger bones to the wrist. Though a fracture can affect any of the metacarpals, the most commonly involved bone is the fifth metacarpal, the one associated with your pinkie finger. A fracture to the fifth metacarpal is often due to punching a hard object with a closed fist, leading to the informal term of “boxer’s fracture”.
Metacarpal fractures are most prevalent among young, active people who are at higher risk of trauma from contact sports, accidents, or occupational injuries. However, older adults with osteoporosis may also be at risk of a metacarpal fracture from a relatively minor impact.
Metacarpal fracture symptoms can include:
The phalanges are the small bones in your fingers and thumb. Each thumb has two phalanges, while the other fingers have three. Phalangeal fractures are common, often due to crush injuries such as when working with heavy machinery or doing manual labour, or injuries from contact or ball sports. Children may sustain a phalangeal fracture from accidents in the playground, or getting a fingertip caught in a door jamb.
Symptoms of a phalangeal fracture can include:
Seeking medical treatment for a suspected phalangeal fracture is important to prevent long-term problems. Complications such as abnormal healing can cause permanently reduced function or chronic pain, while arthritis, nerve, and vascular damage may also result from an untreated fracture.
Diagnosing a hand or wrist fracture involves a combination of identifying a probable cause from your history, a physical examination to look for pain, swelling or bruising, deformity, or reduced function, and imaging such as X-ray, CT, or MRI. Fractures can be isolated but are also often associated with other injuries to consider and manage simultaneously, depending on the circumstances leading up to the fracture.
Treatment for a fracture of the hand or wrist is determined by the location, type, and severity of the break. All treatments are aimed at restoring full function of your hand and/or wrist, relieving pain, and preventing long-term complications.
Conservative treatments for a broken wrist or hand may involve:
For broken bones that involve significant displacement of the bone fragments, fracture in a complicated part of the bone, multiple fractures, or if a joint is involved, surgery may be the most effective option.
Surgery may involve:
After surgery for a broken hand or wrist, you will most likely need to wear a cast or splint for several months while the fracture heals. Some fractures heal faster than others; scaphoid fractures are known to take a while. Dr Fleming will be able to provide realistic recovery timelines based on your age, general health, type of fracture, and location of the injury.
