Overview of finger, hand, and wrist fractures
- Sandeep Sebastin, MMed, FAMS
Sandeep Sebastin, MMed, FAMS
- Consultant, Department of Hand & Reconstructive Microsurgery
- National University Hospital, Singapore
- Kevin C Chung, MD, MS
Kevin C Chung, MD, MS
- Chief of Hand Surgery
- Charles B.G de Nancrede Professor of Surgery
- University of Michigan Health System
- Shimpei Ono, MD, PhD
Shimpei Ono, MD, PhD
- Assistant Professor
- Department of Plastic, Reconstructive, and Aesthetic Surgery
- Nippon Medical School
- Section Editors
- Patrice Eiff, MD
Patrice Eiff, MD
- Section Editor — Adult Orthopedics; Sports-Related Injuries
- Professor of Family Medicine
- Oregon Health & Science University
- Charles E Butler, MD, FACS
Charles E Butler, MD, FACS
- Section Editor — Plastic and Reconstructive Surgery
- The University of Texas, MD Anderson Cancer Center
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Primary care of hand fractures involves accurate diagnosis, pain control, reduction as indicated, immobilization of the fracture, appropriate referral to a hand surgeon, and appropriate rehabilitation once the fracture is healed.
This topic provides an overview of the initial evaluation, identification, and management of finger, hand, and wrist (carpal) fractures. Detailed discussions of specific injuries are found separately. (See "Scaphoid fractures" and "Distal radius fractures in adults" and "Lunate fractures and perilunate injuries" and "Overview of carpal fractures" and "First (thumb) metacarpal fractures" and "Overview of metacarpal fractures" and "Proximal phalanx fractures" and "Distal phalanx fractures" and "Middle phalanx fractures" and "Evaluation of the patient with thumb pain".)
Fractures of the phalanges and metacarpals are among the most common fractures of the skeletal system and account for 10 percent of all fractures . Along with fractures of the carpal bones, they represent a substantial portion of upper extremity fractures . The distal phalanx is the most commonly fractured bone in the hand, followed by the metacarpals . The bones of the hand and wrist are shown in the figure (figure 1).
Metacarpal fractures are seen more often in adults, whereas phalangeal fractures are more common in children . Approximately 20 percent of metacarpal and phalangeal fractures are intra-articular .
Before examining a hand fracture, a quick assessment to rule out any other associated injuries should be carried out. For patients without apparent life-threatening injuries who appear appropriate for office management, assessment begins with a focused history. Analgesia is sometimes needed before a history can be obtained.
- Bernstein ML, Chung KC. Hand fractures and their management: an international view. Injury 2006; 37:1043.
- Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg Am 2001; 26:908.
- Weinzweig N, Gonzalez M. Metacarpal and Phalangeal Fractures, Hanley and Belfus, Inc, Philadelphia 1999.
- Okike K, Bhattacharyya T. Trends in the management of open fractures. A critical analysis. J Bone Joint Surg Am 2006; 88:2739.
- Margić K. External fixation of closed metacarpal and phalangeal fractures of digits. A prospective study of one hundred consecutive patients. J Hand Surg Br 2006; 31:30.
- INITIAL EVALUATION
- RADIOGRAPHIC EVALUATION
- FRACTURE DESCRIPTION
- GENERAL APPROACH
- Open fracture
- Non-displaced fracture
- Displaced fracture
- Fracture reduction
- - Splint placement and position
- - Duration of splinting
- PHALANGEAL FRACTURES
- Distal phalanx fractures
- Middle and proximal phalanx fractures
- METACARPAL FRACTURES
- CARPAL FRACTURES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS