Hand & Wrist Fracture & Dislocation

The hand is one of the most flexible and useful parts of our body. Because of overuse in various activities, the hands are more prone to injuries, such as sprains and strains, fractures and dislocations, lacerations and amputations while operating machinery, bracing against a fall and sports-related injuries.

Fractures

A fracture is a break in the bone, which occurs when force greater than the bearable limit is applied against a bone. The most common symptoms of any fracture include severe pain, swelling, bruising or bleeding, deformity, discoloration of the skin, and limited mobility of the hand.

Diagnosis

The diagnosis of a hand or finger fracture is based on history, physical examinations and X-ray imaging to determine the type and severity of the fracture. X-rays are the most widely used diagnostic tools for the evaluation of fractures.

Treatment

The objective of early fracture management is to control bleeding, provide pain relief, prevent ischemic injury (bone death) and remove sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after the fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical methods.

Non-operative Therapy

The bones can be realigned by manipulating them into place. Following this, splints, casts or braces made up of fiberglass or plaster of Paris material are used to immobilize the bones until they heal. The cast is worn for 3 to 6 weeks.

Surgical Therapy

During surgery, the fracture site is adequately exposed, the bones realigned and reduction of the fracture is done internally using wires, plates and screws and intramedullary nails.

Rehabilitation

Fractures may take several weeks to months to heal completely. You should limit your activities even after the removal of the cast or brace so that the bone becomes solid enough to bear stress. Rehabilitation program involves exercises and gradual increase in activity levels to strengthen the muscles and improve range of motion.

Wrist Fracture

The wrist is comprised of two bones in the forearm (the radius and the ulna) and eight other tiny bones. The bones meet to form multiple large and small joints. A wrist fracture refers to a break in one or more bones in the wrist. Wrist fracture can be caused due to a fall on the outstretched arm or an injury due to accidents such as a car accident or workplace injuries. A wrist fracture is more common in people with osteoporosis, a condition marked by brittleness of the bones.

Common symptoms of a wrist fracture include pain, swelling, and deformity at the wrist site, as well as movement constraint in hand and wrist. More commonly, fracture in radius is seen in many fractures exhibiting deformity of the wrist. Deformity may not be apparent in the case of fractures of the smaller bones such as the scaphoid.

Wrist fractures are simple if the pieces of the fractured bone are well aligned and stable; and unstable if the broken bone fragments are misaligned and cause wrist deformity. Some fractures result in breaking of the joint surface and some don’t. Open (compound) fracture is one in which the broken bone can be seen through the skin. In such a fracture the risk of infection is higher. Misalignment of the bone fragments in a healed fracture might permanently limit motion, cause pain, or arthritis. Your doctor will perform a preliminary examination followed by an X-ray of the wrist to diagnose a fracture and the state of alignment of the bones. Sometimes a CT scan may be used to gather more details of the fracture and the associated injuries. Injuries to ligaments (the structures that hold the bones together), tendons, muscles, and nerves may also occur when the wrist is broken. In such cases these injuries also need to be treated concurrently.

Factors such as age, activity level, hand dominance, previous injuries, and arthritis of the wrist besides other medical conditions, and possible predisposing causes in hobbies and occupation of the patient are considered before treating a wrist fracture. Fractures that are not displaced are treated with either a splint or a cast to hold the wrist in place. For displaced fractures surgery may be needed to properly set the bone and hold it in place, sometimes using external devices, with pins, screws, rods, or plates. These implants are placed deep inside through an incision on the lower or upper side of the wrist.

If the wrist fracture is treated externally, pins are fixed above and below the fracture site and these pins are held in place by an external frame outside the body. This keeps the bone stable until healing occurs. Sometimes, if the bone is crushed or missing, surgical treatment such as bone grafting may be required. Bone grafting involves taking the bone from another part of the body or a bone bank or using a bone graft substitute to treat the fracture. During the period of healing, fingers and shoulder are allowed to remain flexible unless there are other injuries that require their immobilization. When the fracture heals and the limb is stable, you may be asked to do some motion exercises to keep the wrist flexible. In many cases, hand therapy may be indicated to restore flexibility, function, and strength. There is no standard wrist fracture recovery time. While some fractures take a few weeks, some others may take several months to heal.

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