A fracture is a break in the bone. Fractures in the hand are some of the most frequent in the upper extremity. Males between 10 and 40 years of age are most commonly affected. Historically, some fractures are named after the doctor who first described the fracture or the condition that caused it. An example of this is the Bennett’s fracture that represents a fracture at the base of the thumb that extends into the carpometacarpal joint, or the Boxer’s fracture that involves the neck of the fifth metacarpal when punching improperly with the fist on a hard surface. The thumb and small fingers are the most frequently injured digits and are referred to as the border digits which puts them at higher risk of injury because of their proximity to objects when using the hands.
All fractures can be broadly described as closed fractures in which the skin is intact, or Open fractures which involve wounds that communicate with the fracture site, creating contamination and a potential risk for injection. Open fractures therefore require immediate surgical attention. Fractures are also classified according to their radiologic appearance by the geometry and direction, number of fracture fragments, angulation of the fracture fragments, displacement, or compression of the fragments. Fractures are further classified as intra-articular (break through the joint) or extra-articular (outside of the joint). These factors will determine if a fracture is stable or unstable and whether a cast vs surgery is required for definitive treatment.
Fractures that are not separated (displaced), significantly shortened or angulated can often be treated with a splint or cast that takes into consideration the correct alignment of the fracture but also the proper positioning of the other joints not involved in the break in order to avoid stiffness. The fracture usually gains strength around 4-6 weeks after injury and gentle active range of motion exercises can be started at that time or earlier, if the x-rays demonstrate sufficient fracture healing has occurred. The consultation of a therapist will assist in preventing the hand from becoming stiff and will guide the therapy protocol until the best level of activity is achieved.
Fractures of the hand can be complicated by deformity from no treatment, stiffness from prolonged immobilization, and both deformity and stiffness from improper treatment.