Hand Fracture

Overview of hand fracture

Musculoskeletal injuries are common in professional athletes and common people. The World Health Organisation (WHO) reveals that nearly 50% of the current global population suffers from musculoskeletal injuries of some form or the other. While some may resolve in a very short time, others may take a long time to heal. The most common type of musculoskeletal injury observed on a regular basis is bone fractures in hands. These are commonly called “hand fracture”. These may result not only from accidental injuries or stress, but may also arise from certain bone diseases. The NCBI statistics show that an estimated 1.5 million people all over the world suffer from a bone fracture due to some bone disease. This necessitates a proper addressing of the existing bone diseases along with maintaining a healthy diet in order to prevent bone fractures in hands and other parts of the body.

What is hand fracture?

A bone fracture, is a condition characterized by the loss of continuity of a particular bone or multiple bones in the hand due to accidental injury or some bone disease. Hand fracture may result from a trauma injury, high-force impact or stress. It may also be an outcome of diseases like osteogenesis, osteoporosis or bone cancer. In such cases, the fracture is termed as a pathologic bone fracture. A daily diet deficient in essential minerals and micronutrients can also lead to these types of fractures.

What causes hand fractures?

Hand fractures may arise from multiple aetiological factors.

• Repetitive stress
• Overuse injuries
• Accidental injuries
• Injuries due to sports activities (improper strike or defective sports equipment)
• Alterations in structures and properties of the major bones
• Loss of minerals due to aging
• Deficiency of Vitamins A, C, and K in the body
• Deficiency of calcium in the regular diet
• Sudden lifting of heavy loads, especially one that is beyond one’s capacity
• Presence of bony protrusions that may make the bones prone to injury and fracture
• Anatomical defects that are present from birth
• Diseases like Arthritis, Diabetes, and Gout
• Addictive practices like smoking and alcohol consumption

What are some of the common signs of hand fracture?

Hand fractures are easily identifiable through a few common signs and symptoms. These are given below-

• Break in the continuity of periosteum
• Discontinuity in the endosteum
• Edema of the adjoining soft tissues
• Bleeding of the periosteal blood vessels
• Pressure pain
• Muscle spasms an cramps
• Damage to the neighboring structures such as nerves, blood vessels, spinal cord, nerve roots or cranial contents
• Temporary immobility or difficulty moving the fractured part(s)
• Delayed regeneration of the affected tissues and blood vessels

What are the common types of hand fracture?

Hand fractures are mainly of four types. These will be discussed under separate subheadings.

Scaphoid fracture : It is a fracture of the carpal navicular, also known as the scaphoid bone. It is a very common form of carpal bone fracture. It is characterized by pain and swelling at the base of the thumb. Direct axial compression and/or hyperextension of the wrist may occur in this case. The sites that are commonly affected are- the distal third (distal pole), the central third (waist) and the proximal third (the proximal pole).

People having hand fractures are likely to have tenderness of the snuffbox (the triangular depression on the radial and the dorsal face of the hand). The common sites of focal tenderness are as follows-

• Volar prominence at the distal wrist (distal pole fractures)
• Anatomic snuff box (midbody fractures)
• Lister’s tubercule (proximal pole fractures)

Rolando fracture: It is an intra-articular fracture that occurs at the base of the metacarpal bone, which is the first bone that forms the thumb. It is generally Y-shaped or T-shaped.

Bennett’s fracture: It is a type of hand fracture that occurs at the base of the first metacarpal bone, which then extends to the carpometacarpal (CMC) joint. This is a very common fracture of the thumb. It is generally accompanied by the dislocation of the CMC joint. Bennett’s fracture typically presents with-

• Instability and immobility of the CMC joint
• Weakness and pain in the pinch grasp
• Pain, swelling and haemorrhage at the base of the thumb
• Pain experienced while trying to grasp an object

Boxer’s fracture: As the name implies, it is common in professional boxers and athletes. It occurs along a transverse line across the neck of the bone when a patient punches at an object. It is also known as scrapper’s fracture. The breaks occur mainly at the 2^nd, 3^rd, 4^th or 5^th metacarpal bones. Boxer’s fracture typically manifests as-

• Pain, swelling and tenderness at the site of fracture (usually around the knuckle)
• Reddish or bluish discolouration of the injured site
• Snapping or popping sensation
• Abrasions and lacerations
• Misalignment of the injured finger
• Restricted and painful movement of the finger

What are the available diagnostic tests for hand fracture?

After an event of hand fracture, the doctors primarily perform a thorough physical examination. Post-examination, they might recommend the following laboratory examinations-

• Radiographic imaging (X-Ray): To detect the areas of fracture
• Computed Tomography (CT): To detect the nature and degree of fracture
• Magnetic Resonance Imaging (MRI)

How is hand fracture treated?

The treatment and healing of hand fractures is a slow and progressive process. For temporary pain relief, the doctors may recommend ibuprofen, acetaminophen, and codeine. For temporary immobilization of the affected bone, a plaster or a fiberglass cast or a splint that holds the displaced bones in position are used.

Management

Hand fracture should be dealt with very carefully since it often involves the smaller sensitive bones of the hand. Surgical interventions are necessary when the fractures do not heal even after repeated treatments. These conditions should be handled very carefully especially in children. Failure to do so may result in permanent plastic deformation of the bones. Additional systemic complications may also arise in future if diagnosis and treatment are delayed.

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