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| HAND & WRIST PROBLEMS |
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| Hand Fractures |
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| What is a fracture? |
| The hand skeleton is made up of many bones that
form its supporting framework. This frame acts as a
point of attachment for the muscles that make the
wrist and fingers move. A fracture occurs when force
is applied to a bone that is enough to break it. When
this happens, there is pain, swelling, and decreased
use of the injured part. Many people think that a
fracture is different from a break, but they are the
same (Figure 1). Fractures may be simple with the
bone pieces aligned and stable. Other fractures are
unstable and the bone tends to displace or shift.
Comminuted fractures (shattered bone) usually
occur from a high energy force and are often
unstable. An open (compound) fracture occurs
when a bone fragment breaks through the skin.
There is some risk of infection with compound
fractures. |
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| How does it affect the hand? |
| Fractures (or breaks) often take place in the hand. A
fracture can cause pain, stiffness, and loss of
movement. Because of the close relationship of
bones to ligaments and tendons, the hand may be
stiff and weak after the fracture heals. Fractures that
involve joint surfaces may lead to early arthritis in
those involved joints. |
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| How are they treated? |
| Medical evaluation and X-rays are usually needed
so that your doctor can tell if there is a fracture and
to help decide treatment. Depending upon the type
of fracture to your hand, your hand surgeon may
recommend one of several methods of treatment. |
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| A splint or cast may be used to treat a fracture that is
not displaced, or to protect a fracture that has been
set. Some displaced fractures may be held in place
with wires or pins without making an incision. This is
called closed reduction and internal fixation. |
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| Other fractures may need surgery to set the bone.
Once the bone fragments are set, they are held
together with pins, plates, or screws. Occasionally
bone may be missing or be so crushed that it cannot
be repaired. In such cases, a bone graft may be
necessary. In this procedure, bone is taken from
another part of the body to help provide more
stability. |
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| Fractures that have been set may be held in place
by an “external fixator,” a set of metal bars outside
the body attached to pins which are fixed to the
bone above and below the fracture site until the
break heals. |
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| What kind of results can I expect? |
| Perfect alignment of the bone on X-ray is not always
necessary to get good function. A bony lump may
appear at the fracture site as the bone heals and is
known as fracture callus. This functions as a “spot
weld.” This is a normal healing process and the lump
usually gets smaller over time. Problems with fracture
healing include stiffness, shift in position, infection,
slow healing, or complete failure to heal. Smoking
has been shown to slow fracture healing. Fractures in
children occasionally affect future growth of that
bone. You can lessen the chances of complication
by carefully following your hand surgeon’s advice
during the healing process and before returning to
work or sports activities. A hand therapy program
with splints and exercises may be recommended by
your physician to speed and improve the recovery
process. |
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| © Copyright 2003 American Society for Surgery of
the Hand. |
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