Adult
Fractures and dislocations
Hand, wrist and forearm
What it is
These are the fractures and joint displacements of the hand, wrist and forearm: the distal radius — the most common fracture in the body — the scaphoid, the metacarpals, the phalanges, and dislocations of the finger joints.
The mechanism ranges from a fall on the outstretched hand to sporting accidents and crush injuries. Treatment depends less on the name of the bone than on displacement, stability, and whether the joint surface is involved.
Symptoms
Pain, swelling, deformity and an inability to use the hand. A joint may look out of place.
Two points deserve particular attention. First, a finger that crosses over its neighbour when you make a fist indicates a rotational problem, which does not correct itself and must be put right. Second, a scaphoid fracture can be subtle and invisible on the first X-ray: persistent pain at the base of the thumb after a fall warrants a re-check, because a missed scaphoid fracture does badly.
Non-operative treatment
Many fractures are stable and heal very well in a cast or splint, with follow-up X-rays to confirm the position is holding.
For stable finger injuries, buddy taping — strapping the injured finger to its neighbour — allows early movement, which is better than prolonged immobilisation. Setting the bone under local anaesthesia, without surgery, is enough in many cases.
Surgical treatment
Surgery is needed when the fracture is displaced, unstable, involves the joint surface, or is rotated.
Fixation uses plates and screws, wires, or an external fixator, according to the pattern. The scaphoid is often fixed with a single screw, which shortens immobilisation and reduces the risk of non-union — a classic problem with this bone, whose blood supply is precarious.
Recovery expectations
How long depends on the bone and the fixation. It is worth knowing that in the hand the main enemy is not the fracture but stiffness: that is why therapy starts early as soon as the fixation allows.
Swelling and dull aching last for months, which is normal and does not indicate a problem. Elevating the hand and moving the fingers from the first days reduces these after-effects considerably. Return to heavy work and contact sport waits for X-ray confirmation that the bone has healed.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.