Broken hand

Overview

A broken hand is a break or crack in one or more of the bones of your hand. This injury can be caused by direct blows or falls. Motor vehicle crashes can cause hand bones to break, sometimes into many pieces, and often require surgical repair.

You may be at higher risk of a broken hand if you participate in contact sports like football or hockey, or if you have a condition in which bones become thinner and more fragile (osteoporosis).

It's important to treat a broken hand as soon as possible. Otherwise, the bones might not heal in proper alignment, which might affect your ability to do everyday activities, such as writing or buttoning a shirt. Early treatment will also help minimize pain and stiffness.

Symptoms

A broken hand might cause these signs and symptoms:

• Severe pain that might worsen when gripping or squeezing or moving your hand
• Swelling
• Tenderness
• Bruising
• Obvious deformity, such as a crooked finger
• Stiffness or inability to move your fingers or thumb
• Numbness in your hand or fingers

When to call a doctor

If you think you might have a broken hand, see a doctor immediately, especially if you have numbness, swelling or trouble moving your fingers. A delay in diagnosis and treatment can lead to poor healing, decreased range of motion and decreased grip strength.

Causes

Hand fractures can be caused by a direct blow or crushing injury. Motor vehicle crashes can cause hand bones to break, sometimes into many pieces, and often require surgical repair.

Risk factors

Your risk of a broken hand may be increased if you participate in sports like football, soccer, rugby, or hockey. Osteoporosis, a condition that weakens bones, may also increase your risk of a broken hand.

Complications

Complications of a broken hand are rare, but they might include:

• Ongoing stiffness, aching or disability. Stiffness, pain or aching in the affected area generally goes away eventually after your cast is removed or after surgery. However, some people have permanent stiffness or pain. Be patient with your recovery, and talk to your doctor about exercises that might help or for a referral to physical or occupational therapy.
• Osteoarthritis. Fractures that extend into a joint can cause arthritis years later. If your hand starts to hurt or swell long after a break, see your doctor for an evaluation.
• Nerve or blood vessel damage. Trauma to the hand can injure adjacent nerves and blood vessels. Seek immediate attention if you have numbness or circulation problems.

Prevention

It's impossible to prevent the unforeseen events that often cause a broken hand. But these tips might offer some protection.

Build bone strength

To build strong bones:

• Eat a nutritious diet with adequate calcium and vitamin D
• Get plenty of weight-bearing exercise, such as brisk walking
• Quit smoking if you're a smoker

Prevent falls

Hand fractures can occur when people fall forward onto an outstretched hand. To prevent this common injury:

• Wear sensible shoes
• Remove things you can trip over in your home, such as throw rugs
• Light up your living space
• Have your vision checked and, if needed, corrected
• Install grab bars in your bathroom
• Install handrails on your stairways
• Avoid slippery surfaces, if possible, such as snow- or ice-covered walkways

Diagnosis

The diagnosis of a broken hand generally includes a physical exam of the affected hand and X-rays.

Treatment

If the broken ends of the bone aren't aligned, there can be gaps between the pieces of bone or fragments might overlap. Your doctor will need to manipulate the pieces back into position, a procedure known as a reduction. Depending on the amount of pain and swelling you have, you might need a local or general anesthetic before this procedure.

Whatever your treatment, it's important to move your fingers regularly while the fracture is healing to keep them from stiffening. Ask your doctor about the best ways to move them. If you smoke, quit. Smoking can delay or prevent bone healing.

Immobilization

Restricting the movement of a broken bone in your hand is critical to proper healing. To do this, you'll likely need a splint or a cast. You'll be advised to keep your hand above heart level as much as possible to reduce swelling and pain.

Medications

To reduce pain, your doctor might recommend an over-the-counter pain reliever. If your pain is severe, you might need an opioid medication, such as codeine.

NSAIDs can help with pain but might also hamper bone healing, especially if used long-term. Ask your doctor if you can take them for pain relief.

If you have an open fracture, in which you have a wound or break in the skin near the wound site, you'll likely be given an antibiotic to prevent infection that could reach the bone.

Therapy

After your cast or splint is removed, you'll likely need rehabilitation exercises or physical therapy to reduce stiffness and restore movement in your hand. Rehabilitation can help, but it can take several months or longer for complete healing.

Surgical and other procedures

You might need surgery to implant pins, plates, rods or screws to hold your bones in place while they heal. A bone graft might be used to help healing. These options might be necessary if you have:

• An open fracture
• A fracture in which the bone pieces move before they heal
• Loose bone fragments that could enter a joint
• Damage to the surrounding ligaments, nerves or blood vessels
• Fractures that extend into a joint

Even after reduction and immobilization with a cast or splint, your bones can shift. So your doctor likely will monitor your progress with X-rays. If your bones move, you might then need surgery.

Preparing for your appointment

You might first seek treatment for a broken hand in an emergency room or urgent care clinic. If the pieces of broken bone aren't lined up properly to allow healing with immobilization, you might be referred to a doctor specializing in orthopedic surgery.

What you can do

You may want to write a list that includes:

• A description of your symptoms and how, where and when the injury occurred
• Information about your and your family's medical histories
• All the medications and dietary supplements you take, including doses
• Questions you want to ask the doctor

For a broken hand, questions to ask your doctor include:

• What tests do I need?
• What's the best course of action?
• Will I need surgery?
• Will I need to wear a cast? If so, for how long?
• Will I need physical therapy when the cast comes off?
• Are there restrictions that I need to follow?
• Should I see a specialist?

What to expect from your doctor

Your doctor might ask:

• What is your occupation?
• Was your hand bent backward or forward when the impact occurred?
• Are you right-handed or left-handed?
• Where does it hurt, and do certain movements make it hurt more or less?
• Have you had previous hand injuries or surgery?