Bone Fractures in the Hand and Upper Extremity

A fracture, also called a broken bone, often results from a high force or impact. A bone may be fractured completely or partially in several ways: crosswise, lengthwise and in multiple pieces. Most fractures are caused by trauma, but some can be the result of an underlying disease that increases the chance of fracture.

The Orthopaedic hand team at Brigham and Women’s Hospital (BWH) are experts at diagnosing and treating all types of fractures affecting the 27 bones of the hand and wrist. Many of these injuries can be treated without surgery. We offer a range of treatment options, including casts, splints and surgical procedures that use wires, pins, plates, and screws to stabilize and align bones.

Types

Common types of fractures include:

  • Stable fracture, when bone pieces are aligned
  • Unstable fracture, when bone fragments have shifted
  • Open (compound) fracture, when the bone breaks through the skin
  • Transverse fracture, when the fracture has a horizontal fracture line
  • Oblique fracture, when the fracture has an angled pattern
  • Comminuted fracture, when the bone shatters into many pieces

Fractures can occur in virtually any area, including:

  • Fingers
  • Wrist, often the distal radius
  • Forearm bones (radius and ulna)
  • Elbow
  • Humerus
  • Shoulder
  • Clavicle (collarbone)

Causes

Fractures can be caused by a number of factors, including:

  • Trauma such as a fall, motor vehicle accident, or direct impact during an athletic activity
  • Osteoporosis, a disorder that weakens bones and makes them more likely to break

Symptoms

Symptoms can include:

  • Pain
  • Stiffness
  • Swelling and tenderness
  • Weakness
  • Bruising
  • Crooked or deformed appearance
  • Depressed knuckle of hand
  • Difficulty moving
  • Numbness or tingling
  • Bone puncturing the skin (an emergency)

Diagnosis

Your orthopaedic surgeon will evaluate your medical history and may conduct a variety of tests to determine if you have a fracture:

  • Physical examination
  • X-ray
  • Computed tomography scan (CT or CAT scan)
  • Magnetic resonance imaging (MRI)

Treatment

Non-surgical Treatment

Often, bones can be realigned without surgery. Non-surgical treatments include:

  • Pain medication
  • Sling, cast or splint to immobilize the bone
  • Traction to stabilize and realign the bone

Surgical Treatment

If non-surgical treatment does not relieve your symptoms, surgery may be recommended. Surgical approaches include:

  • Closed reduction and pinning involves repositioning of bone fragments without an incision and placing a pin or wire under X-ray guidance.
  • Open reduction and internal fixation involves repositioning of bone fragments with the use of special screws or metal plates to the outside of the bone.
  • External fixation involves the implantation of wires, metals, pins, screws or plates into the broken bone above and below the fracture site.
  • Bone graft involves taking healthy bone from another part of the body to repair bone that has been crushed.

Recovery

The length of recovery varies for each injury and each individual. Fractures can take weeks to months to heal depending on the severity of the injury.

Physical therapists and occupational therapists can help speed your recovery through strength and flexibility exercises. Hand therapy is often recommended to regain the use of a hand following an upper extremity fracture.

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