Hand Fractures

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG) | MRCS (Edin) | MMed (Surgery) | FAMS (Hand Surgery)

Hand fractures occur when one or more bones in the hand break. These include the metacarpals (palm bones) and phalanges (finger bones). Causes range from falls and direct impacts to crush or twisting injuries. Such fractures can significantly impact hand strength, flexibility, and function, limiting daily activities and work capabilities.

While most hand fractures heal well without surgery, certain cases, such as displaced, comminuted, or intra-articular fractures, may require surgical intervention.

Symptoms Causes Types Diagnosis Treatment Prevention FAQ

Symptoms of Hand Fractures

Recognising symptoms early allows prompt treatment to prevent complications. Common symptoms include:

Severe Pain and Tenderness: Pain occurs immediately after the injury and intensifies with movement or pressure. It may radiate across the affected area.
Swelling and Bruising: Swelling develops rapidly, and bruising appears within hours, indicating damage to surrounding tissues.
Deformity: The hand or fingers may appear visibly misaligned or bent compared to the uninjured side.
Difficulty Moving: Movement of the hand or fingers may be restricted or painful due to mechanical disruption or severe discomfort.
Audible Snap: A snapping or cracking sound at the moment of injury may indicate a fracture.
Crepitus: A grinding sensation during movement suggests bone fragments rubbing against each other.

Causes and Risk Factors

Hand fractures are typically caused by physical trauma, and several factors can increase the risk.

Direct Impact: Blows or falls onto an outstretched hand can cause fractures due to sudden force.
Sporting Accidents: Contact sports, falls, or impact with equipment are common causes of hand injuries.
Workplace Injuries: Industrial and construction jobs expose workers to crushing or impact injuries.
Crushing or Twisting Forces: Severe accidents involving heavy objects or rotational forces can result in complex fractures.
Age and Bone Health: Older adults with reduced bone density are more prone to fractures even from minor trauma.
Previous Injuries: Bones weakened by prior fractures or untreated trauma are more susceptible to new injuries.

Types of Hand Fractures

Hand fractures vary widely in both their location within the hand and the severity of the break.

Metacarpal Fractures

These occur in the palm bones, often from punching or falls. A common subtype is the “boxer’s fracture”, which involves the fifth metacarpal and may cause rotational deformity.

Phalangeal Fractures

Fractures in the finger bones vary from simple breaks to more severe cases involving joints. Without proper alignment, these can lead to stiffness or deformity.

Intra-articular Fractures

These fractures extend into the joint surfaces, requiring precise alignment during treatment to prevent arthritis and preserve mobility.

Diagnosis of Hand Fractures

Physical Examination

A doctor assesses the hand for deformities, swelling, tenderness, and functional limitations. Adjacent areas like the wrist and forearm are also checked to rule out associated injuries. Circulation and sensation tests ensure that nerves and blood vessels are intact.

Imaging Studies

Imaging studies are necessary for diagnosing hand fractures. X-rays provide detailed views of the fracture location, type, and severity, with additional angles used for complex cases. CT scans offer cross-sectional details, making them particularly useful for fractures involving joints or multiple fragments and for surgical planning.

Treatment Options

Treatment depends on the fracture type, severity, and patient factors such as activity level and age.

Non-Surgical Treatment

Splinting

Custom splints immobilise the fractured bone while preserving movement in unaffected joints. This method is suitable for stable fractures and requires regular x-rays to monitor healing progress.

Casting

Casts provide complete immobilisation for unstable fractures, ensuring proper alignment and healing. The cast is typically worn for 4–6 weeks, depending on the severity of the injury.

Buddy Taping

This method involves taping a stable fractured finger to a neighbouring healthy finger for support. It helps maintain alignment while allowing limited, controlled movement.

Surgical Treatment

Pins and Wires

Thin metal pins are inserted through the skin to stabilise simple fractures by holding the bone fragments in proper alignment. This minimally invasive technique is particularly effective for smaller bones, and the pins are typically removed after 4–6 weeks once the fracture has healed sufficiently.

Plates and Screws

Metal plates and screws are used to fix unstable or displaced fractures. These devices are attached directly to the bone, providing robust and long-term stability. This method not only ensures proper alignment but also facilitates early movement, reducing the risk of stiffness and promoting faster functional recovery.

External Fixation

An external frame is used to stabilise complex fractures, such as those caused by severe crushing or infection. Pins are inserted through the skin and into the bone, connecting to the external frame. This temporary solution preserves bone alignment and protects the fracture site while the surrounding soft tissues recover and heal.

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Prevention and Management

Hand fractures can often be prevented by using protective equipment during sports and high-risk activities, such as gloves or padding. Maintaining bone health through regular exercise, sufficient calcium, and vitamin D intake also reduces fracture risks. After treatment, adhering to a hand therapy regimen is necessary for restoring mobility, strength, and functionality. Regular follow-ups with your doctor ensure proper healing and allow early detection of any complications.

Frequently Asked Questions

Can a hand fracture cause long-term complications?

Untreated or improperly treated hand fractures can result in chronic pain, reduced range of motion, post-traumatic arthritis, or permanent deformities that affect hand function.

How soon after a fracture can I start physical therapy?

Physical therapy generally starts once the bone has sufficiently healed to allow safe movement, typically 4–6 weeks after the injury. The exact timing depends on the fracture’s severity, the treatment method, and the patient’s progress during follow-ups.

Can fractures weaken bones permanently?

Bones usually regain full strength after healing, provided they are treated properly. However, repeated fractures in the same area, poor healing, or underlying conditions such as osteoporosis can increase long-term bone fragility.

Dr Jacqueline Tan

Senior Consultant Hand Surgeon

MBBS (SG)

MRCS (Edin)

MMed (Surgery)

FAMS (Hand Surgery)

Dr. Jacqueline Tan is a hand surgeon in Singapore with over 18 years of experience in managing hand, wrist, and nerve conditions. Formerly the Head of Department of Hand and Reconstructive Microsurgery at Singapore General Hospital, she has continued to contribute significantly to her profession.

Director of Micro-Reconstruction Service and the Director of Peripheral Nerve and Paralytic Upper Limb Service
Upon the completion of her training as a hand surgeon in Singapore, Dr Tan was awarded the prestigious Health Manpower Development Plan scholarship by the Ministry of Health (MOH).
Completed a one-year advanced fellowship in Taiwan under the tutelage of internationally-acclaimed Hand and Orthopedic Microsurgeon – Professor Yuan-Kun Tu
Dr Tan’s field of expertise is in early and late brachial plexus reconstruction, peripheral nerve disorders, reconstructive microsurgery of the extremities and wrist disorders.

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