Fracture of the Hand (Broken Hand)

First aid for a suspected broken hand

1. Remove rings and watches immediately, before swelling makes this impossible.
2. Keep the hand still. Support it with a padded splint or a folded magazine and a sling if available.
3. Apply ice wrapped in a cloth for 15 to 20 minutes at a time.
4. Raise the hand above heart level to reduce swelling.
5. Cover any wound with a clean dressing.
6. Take pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose.
7. Get the hand examined, usually the same day.

Bones of the hand

• Metacarpals: 5 long bones in the palm, connecting the wrist to the fingers
• Phalanges: 14 finger bones; each finger has three (proximal, middle and distal), the thumb has two
• Carpals: 8 small wrist bones, including the scaphoid. Wrist fractures are covered separately in wrist fracture and scaphoid fracture

Common types of hand fracture

See metacarpal fracture and finger fracture for more detail on each.

Symptoms

• pain, worse with gripping or moving the fingers
• swelling and bruising, often spreading to the back of the hand
• tenderness over a specific bone
• visible deformity, such as a sunken knuckle or a bent finger
• a finger that rotates or crosses over a neighboring finger when you make a fist (scissoring)
• shortening of a finger
• numbness or tingling in a finger

Diagnosis

A doctor will check each bone for tenderness, look at finger alignment with the fingers straight and in a gentle fist, test tendon function and sensation, and look for wounds. X-rays from several angles confirm the fracture and show displacement. CT is sometimes used for fractures into joints.

Treatment

The goals are to restore alignment, especially rotation, and to start moving early to avoid stiffness.

Non-surgical treatment

Most hand fractures are stable and heal with:

• Splint or cast for 3 to 4 weeks, holding the knuckles bent at about 70 to 90 degrees to prevent stiffness
• Buddy taping to a neighboring finger for some stable finger fractures
• Closed reduction: the doctor realigns the bones under local anesthetic, then splints them
• Boxer's fractures often heal well with a short period of splinting or buddy taping, even with some angulation, as long as there is no rotation

Surgery

Surgery is recommended for:

• fractures with rotation or significant shortening
• unstable fractures that will not stay aligned
• fractures into a joint with a step in the joint surface
• open fractures (bone through the skin)
• multiple fractures

Methods include wires (K-wires), screws and plates. Wires are often removed after 3 to 4 weeks.

Open fractures and fight bites

A wound over a fracture needs antibiotics, washing out and often surgery. A cut over a knuckle from a punch to the mouth is treated as a human bite, with antibiotics and sometimes surgical cleaning, because infection can spread into the joint.

Healing time and recovery

Hand therapy helps restore movement and grip. Stiffness is the most common long-term problem, so follow your exercise plan.

Complications

• stiffness and loss of finger movement
• malunion: healing in a rotated or shortened position, causing scissoring or weak grip
• nonunion (rare)
• infection, especially with open fractures and fight bites
• arthritis after joint fractures
• tendon irritation from plates

Frequently asked questions

How do I know if my hand is broken?

Signs include pain over a specific bone, swelling, bruising, deformity, difficulty gripping, and a finger that rotates or overlaps another when you make a fist. Being able to move your fingers does not rule out a fracture. An X-ray is needed to confirm it.

How long does a broken hand take to heal?

Most hand fractures heal in about 4 to 6 weeks. You may wear a splint or cast for 3 to 6 weeks. Full strength and flexibility can take 2 to 3 months, and hand therapy helps.

What is a boxer's fracture?

It is a break in the neck of the metacarpal bone below the little finger knuckle, usually from punching a hard object. The knuckle may look sunken. Many heal well with a splint or buddy taping, but a rotated finger or skin wound needs further treatment.

Can a broken hand heal without a cast?

Some stable fractures, such as many boxer's fractures and simple finger fractures, heal well with buddy taping or a removable splint, allowing early movement. A doctor needs to confirm the fracture is stable and properly aligned first.

Do I need surgery for a broken hand?

Most hand fractures do not need surgery. Surgery is recommended for fractures that are rotated, shortened, unstable, extend into a joint, are open, or involve several bones.