Hand fracture fixation
The treatment that is most suitable for your hand fracture is determined by a number of factors, including age, present health, health history, the severity and location of the fracture and history with other medications and treatments. Hand fracture, which is a break in one or more of the bones in the hand, most often occurs after a significant trauma.
A hand fracture can limit your ability to perform daily tasks, and without treatment it can lead to deformity. If you have any reason to think your hand has been fractured, it is important to get medical attention. To best diagnose your injury, the doctor will ask questions about your medical history and recent activity and if there was any trauma, then perform a physical exam. If the exact location of the fracture is unknown, one or more of these tests will be used to determine where it is:
- X-ray (radiograph) – This usually will be the first test done to try to locate any abnormalities. Electromagnetic radiation is used to produce images of your hand and wrist to check for any breakages. Bone stands out in a radiograph because it absorbs the radiation, making it easier to see fractures.
- Computed tomography scan (CT or CAT scan) – A CAT scan combines the X-ray approach with computer-generated technology to create a more complex image. When an X-ray does not adequately show any breakages, this may be used instead.
- Magnetic resonance imaging (MRI) – Different from X-rays and CAT scans, MRIs use a magnetic field and radio waves to generate an image instead of radiation. You’re placed in a tube and radio waves are aimed at your hand and wrist, causing them to vibrate. A computer then translates the rate of the vibrations into a high-definition image.
If the hand fracture is minor, it can be treated with a nonsurgical approach. If the fingers are damaged, they may be placed in a finger splint so that the rest of the hand can remain mobile while the finger repairs. If other bones are damaged, they may require a cast or splint to stabilize the entire hand while the bones heal from the breakage. Antibiotics and pain killers may be given to help reduce the risk of infection and to ease the pain from the trauma.
In some cases, when the breakage is severe, a hand fracture requires surgery. The goal of most hand fracture surgeries is to reconnect the bones and hold them in place so they do not cause any permanent deformities. The majority of hand fractures are treated using one of these three techniques:
- Percutaneous pin fixation – This is the most common surgical technique to fixate hand fractures. The bones become more stable by placing pins through the skin and into the bones to keep them straight.
- Internal fixation with metal plates and screws – To help stabilize the bone, the doctor will make an incision and place metal plates along the broken bones to realign them and stabilize them as they heal. Screws are then affixed to the bones to help them remain in place.
- External fixation – When there is significant damage to the skin and tissue, making further incisions may be dangerous or risk causing an infection. In this case, external fixation involves attaching rods or plates to the outside of the hand and screwing them into the bone through the skin. This is the most minimally invasive of the surgeries.
Much of the research surrounding hand fractures has to do with falls in the elderly. Osteoporosis is a disease that affects primarily postmenopausal women and some men over the age of 50. When men and women age, bone mass density declines, making them more susceptible to fractures. They are also more prone to falling. As a fall occurs, the natural reaction is to reach out and try to stop the fall. This leaves the hand in particular vulnerable to fracture.
One of the biggest difficulties is determining what causes osteoporosis at an early age, a condition known as idiopathic osteoporosis. This type of osteoporosis most commonly affects men between the ages of 50 and 69, which may be one reason why men account for more hand fractures than women. The cause of idiopathic osteoporosis is unknown and is still being researched.
Therapy treatments to try to reduce the effects of idiopathic osteoporosis are still being researched. They include vitamin D intake, calcium intake and lifestyle changes. One of the most commonly suspected reasons for this disease is the use of steroids or glucocorticoid by men. In this case, new treatments are being used to reduce the impact of steroids and reverse the osteoporosis caused by these drugs.
As research on glucocorticoid reduction therapy is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs hand fracture surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.