Your hands play such an important role in how you interact with the world around you. Breaking one of your hand bones can mean weeks (or longer) of learning new or different ways of navigating your routine. The bones in a normal hand line up precisely, letting you perform many specialized functions like grasping a pen or manipulating small objects in your palm. When you fracture a finger bone, it can put your whole hand out of alignment. Without treatment, your broken finger may stay stiff and painful. A delay in diagnosis and treatment can lead to poor healing, decreased range of motion, and decreased grip strength.  For optimal results, you should see one of the highly respected and foremost-in-their-field hand specialists at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or  Aurora, Aurora, Colorado.

OVERVIEW

A “broken hand” is the same as a “hand fracture” – both terms refer to a break or crack in one or more bones within the hand; they are essentially the same thing, medically speaking. Hand fractures are some of the most commonly broken bones. Metacarpal fractures are especially common. One in 10 of all broken bones is a metacarpal fracture. They’re also the most common hand injury for people ages 18 to 34.

The metacarpal bones-also known as the “palm bones,” are the five long bones that make up the palm of the hand, situated between the wrist bones (carpals) and the finger bones (phalanges); they are numbered 1-5, with the first metacarpal belonging to the thumb and the fifth metacarpal belonging to the little finger. Anyone can break their hand, but some people are more likely to, including:

• People younger than 40.
• Athletes (especially people who play contact sports or practice martial arts).
• People with a health condition that affects their bones.

To be diagnosed as a hand fracture, one of the bones may be broken into multiple pieces, or several bones may be affected. This is different from a sprained hand, which is the result of an injury to the muscle, tendon, or ligament.

ABOUT THE HANDS

About one-quarter of all the body’s bones are found in the hands. The human hand is a complex structure of bones, muscles, ligaments, tendons, nerves, blood vessels, and soft tissue that allows for a wide range of movement and dexterity. Ligaments are tough bands of connective tissue that support and keep bones in place. Important ligaments in the hand include the collateral ligaments, which prevent sideways movement of the finger and thumb joints. Tendons work with the bones to enable movement. Arteries: The radial artery runs along the radius bone, and the ulnar artery runs along the ulna bone. These arteries form arches in the hand that supply blood to the fingers. The radial nerve controls the position of the hand and stabilizes it. The palms and undersides of the fingers have ridges called fingerprints and palm prints that improve grip and tactile sensitivity. 

 There are 27 bones in each of the hands. Providers group them by their location and function:

• Carpals: The small bones that connect the hand to the wrist.
• Metacarpals: The five bones in the palm that give it its shape.
•  Phalanges: The individual bones that make up the segments of the fingers and thumb.

With nineteen bones to look after regularly, it is not uncommon for many different types of fractures to occur, resulting in trauma to the hand. The most common age for a hand fracture in adults is 14 years for males and 13 years for females. Males have a higher risk of hand fractures than females, especially between the ages of 15 and 40. Elderly women are more likely to injure their hands than men, and falls are the most common cause of hand fractures in this age group. 

WHAT IS A HAND FRACTURE?

There are well over 100 distinct types of hand fractures when accounting for all possible location, pattern, and characteristics combinations. The break’s shape or pattern classifies some fractures. Some by how they happen. Some have their own unique name. The main types of hand fractures include:

1. Simple/Closed Fractures: The bone breaks but doesn’t pierce the skin. Common in metacarpals and phalanges.
2. Compound/Open Fractures: The bone breaks and penetrates through the skin, creating risk of infection.
3. Comminuted Fractures: The bone breaks into three or more pieces. Often seen in crush injuries.
4. Spiral Fractures: A twisting injury causes the bone to break in a spiral pattern around the shaft.
5. Intra-articular Fractures: The break extends into a joint surface, potentially leading to arthritis if not properly treated.
6. Avulsion Fractures: A small piece of bone is pulled off by a tendon or ligament.
7. Malunion: The bone heals in an incorrect position or alignment.
8. Stress Fractures: Tiny cracks that develop from repetitive stress, though these are less common in hand bones.

Some of the uniquely named fractures are:

9. Boxer’s Fracture: A break in the neck of the 5th metacarpal, usually from punching something such as a wall
10. Bennet’s Fracture: known as the 1st metacarpal fracture at the base of the thumb
11. Reverse Bennet’s Fracture: a 4th and 5th metacarpal fracture/dislocation
12. Rolando’s fracture: at the thumb base
13. Gamekeeper’s/Skier’s thumb: “Gamekeeper’s thumb” comes from Scottish gamekeepers who would kill rabbits by breaking their necks, causing chronic stress to this ligament over time. “Skier’s thumb” refers to the acute injury when falling while holding a ski pole, causing sudden forceful thumb abduction.
14. Jersey finger: The name comes from its common occurrence in American football when a player grabs another player’s jersey, and the finger gets caught and forcefully extended while actively flexing.
15. Mallet finger: (also known as baseball finger or drop finger) Common in sports when a ball strikes the fingertip. It can also occur from relatively minor trauma like tucking in bed sheets

CAUSES

Because there are so many different types of fractures, each has its own unique causes. However, broadly speaking,  major causes of hand fractures include:

Direct trauma:

• Falls onto an outstretched hand (FOOSH injuries)
• Punching hard objects or surfaces (boxer’s fracture)
• Crushing injuries from heavy objects
• Sports injuries from direct impacts with balls, equipment, or other players

Motor vehicle accidents:

• Steering wheel impacts
• Airbag deployment injuries
• Motorcycle and bicycle accidents
• Door/window crushing injuries

Workplace injuries:

• Machinery accidents
• Construction site incidents
• Heavy equipment accidents
• Tools or materials striking the hand

Sports-specific injuries:

• If one participates in sports like football, hockey, soccer (especially the goalkeeper), boxing, or rugby, they are at higher risk of breaking the hand.
• Contact sports martial arts
• Skateboarding or rollerblading falls
• Rock climbing accidents

Pathological causes:

• Osteoporosis leading to weakened bones (result of age)
• Bone tumors (rare)
• Repetitive stress injuries that weaken bone

SYMPTOMS

Different fractures have different causes, and the same is the case with symptoms of different fractures. A comprehensive overview of symptoms can help ensure timely medical attention:

• Severe pain that worsens with movement or touch
• Swelling around the injured area
• Bruising and discoloration
• Obvious deformity or misalignment of fingers/hand
• Tenderness and warmth at the fracture site

Movement-Related Signs:

• Reduced grip strength
• Limited range of motion in fingers or thumb
• Difficulty making a fist
• Pain when trying to grasp objects
• Stiffness in the affected area
• Inability to perform normal hand functions

Visible Changes:

• Fingers may appear shortened
• Knuckle may be missing or appear sunken (especially in boxer’s fractures)
• Visible bone displacement in severe cases
• The skin may be broken in compound fractures
• Swelling can cause fingers to look sausage-like

Associated Symptoms:

• Numbness or tingling if nerves are affected
• Cold or bluish fingers if blood flow is compromised
• Muscle spasms around the injury
• General weakness in the hand
• Clicking or grinding sensation with movement

Late-Appearing Signs:

• Persistent stiffness
• Developing bruising patterns
• Increasing pain with use
• Progressive swelling
• Weakness that doesn’t improve

NON-SURGICAL TREATMENTS

Initial treatment would be to follow the RICE protocol: rest, ice, compression, elevation (raising the arm above the heart level). Over-the-counter non-steroidal medications (NSAIDs like ibuprofen and Naproxen ) can help relieve pain. Conservative treatments would include immobilization. This may include custom-made splints or casts, finger splints for individual digit fractures, or buddy taping (strapping injured finger to adjacent healthy finger).  Once the doctor approves physical therapy with gentle range of motion exercises and hand strengthening exercises may be added.

WHEN IS SURGERY INDICATED?

Surgery for hand fractures is typically indicated when non-surgical treatments (like immobilization with a splint or cast) are unlikely to result in proper healing or functional recovery. Indications for surgery depend on the type, location, and severity of the fracture, as well as the patient’s needs and activities. Here are the key situations where surgery may be recommended:

1. Failure of Non-Surgical Treatment

• If a fracture fails to heal properly (nonunion or malunion) with conservative methods, surgical intervention may be necessary.

2. Displacement or Angulation

• The fracture fragments are significantly misaligned and cannot be corrected with closed reduction (manual alignment).
• Residual angulation, rotation, or shortening would impair hand function.

3. Open Fractures

• When the fracture is associated with a break in the skin, surgery is necessary to clean the wound, reduce the risk of infection, and stabilize the fracture.

4. Joint Involvement

• Intra-articular fractures (those involving a joint surface) require precise alignment to prevent arthritis and maintain joint movement.
• Surgery ensures accurate reduction and stabilization of the joint surface.

5. Unstable Fractures

• Fractures that cannot maintain alignment with conservative treatment, such as comminuted (multiple fragments) fractures or those with significant soft tissue involvement.

6. Neurovascular Compromise

• If the fracture causes pressure on nerves or blood vessels, surgery may be needed to relieve the pressure and repair the structures.

7. Rotational Deformities

• If the fracture causes the fingers to overlap or rotate incorrectly when the hand is closed, this can impair grip function and require surgical correction.

8. Specific Patient Needs

• High-performance requirements (e.g., athletes, musicians, or manual laborers) may necessitate surgery to ensure optimal recovery and functionality.
• Manual laborers needing rapid return to work

GETTING THE RIGHT DIAGNOSIS.  GETTING THE RIGHT DOCTOR.

Since our hands are essential for nearly everything we do daily, investing in the best possible surgical care can significantly improve long-term outcomes. Imagine, as we said, there are well over 100 types of hand fractures. You won’t find more knowledgeable, accomplished, and caring hand specialists and surgeons than at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado. They bring critical advantages to your experience and outcome using state-of-the-art techniques and technology. They have advanced training in microsurgery, considering hand surgery often involves working with structures as tiny as 1-2 millimeters. The small size of hand bones and their intricate relationships require the surgical precision you’ll get at Advanced Orthopedics. With their experience in evaluation, they can better assess the full extent of injury, including damage to surrounding soft tissues that may not be obvious on initial X-rays. Their deep understanding of hand biomechanics gives them better judgment in complex cases. They can grasp how seemingly minor surgical decisions can have major functional impacts on your life. For instance, if a finger joint is repaired at even a slightly wrong angle, it can affect something as simple as precise pinching movements needed for tasks like buttoning clothes. Your surgeon will answer all your questions in language that’s easy to understand to help you make your own decisions regarding your treatment. They want you to feel comfortable and at ease from the time you first meet them until the time you can get out to do the things you love to do and need to do.