Hand & wrist fracture treatment
What is hand & wrist fracture treatment?
A hand fracture is a break in one or more of the bones in the hand and most often occurs after a significant trauma. A wrist fracture is full or partial breakage of one or both of the forearm bones, or one or more of the seven small wrist bones that, all together, make up the wrist. Wrist fractures are among the most common broken bone injuries—making up approximately 16 percent of all fractures seen in the emergency room.
The most suitable treatment for your hand or wrist 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.
Much of the research surrounding hand and wrist fractures has to do with falls in the elderly, especially those with osteoporosis. 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 and wrist 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 and women between the ages of 50 and 69. The cause of idiopathic osteoporosis is unknown and is still being researched, as are therapy treatments to try to reduce the effects of the condition. They include vitamin D intake, calcium intake and lifestyle changes. The most commonly suspected reasons for this disease is the use of steroids or glucocorticoid by men, and hormonal changes during menopause in women; in this case, new treatments are being used to reduce the impact of steroids and reverse the osteoporosis caused by drugs and the loss of calcium in bones during and after menopause.
Because older women are especially susceptible to fractures, one focus is on selective estrogen receptor modulators (SERMs). While these drugs have proven to help prevent certain fractures, other major bones are still exposed to risk of breakage, so research continues to seek a solution that will help treat the symptoms of osteoporosis while also treating all bone types.
Types of hand & wrist fracture treatments
A wrist fracture is one of the easiest types of bone breakages to treat without surgery. Typically, a casting method is used to immobilize the bone while it heals. In some cases, the wrist may have come out of alignment when it broke; when this happens, the doctor may use local anesthesia to realign the wrist and put it on the right track for healing.
If a 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 injured portion of the 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, especially when the bones have shifted out of normal position, a wrist fracture will require surgery. The aim of most wrist fracture surgeries is to help guide the bones back into place and hold them while the bone fragments heal. Wrist fractures are almost always treated using one of these three techniques:
- Plate and screws—When surgery is required on the wrist, it is usually due to damage that will not allow the bones to heal together using a nonsurgical intervention. In these situations, plates and screws may be used to connect the bones that separated during the breakage.
- External fixation—External fixation to realign and guide the bones during recovery is another way orthopedic surgeons can help bones heal correctly. In these situations, wires are placed into the broken bones and an external rod is used to hold the wires and guide the wrist back to the correct alignment while the bones heal.
- Kirschner wire fixation—In some rare occasions, when the wrist bones shatter, Kirschner wires (or K-wires) are used to repair the breakage. Usually a cast is added to support the wires and broken bones until the bones heal.
Hand fractures can also require surgery in severe cases. 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, and a cast is added to hold the bones while they heal.
- 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 used to hold the plates on the bones while they heal. One important advantage of plates and screws is that patients can start to move the hand and fingers early, which helps regaining motion and function.
- 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.