Broken hand

This article describes how a fracture of the carpal bones or metacarpal bones occurs and what treatment options are available.

The hand consists of three parts. Starting at the wrist, there are first eight carpal bones (carpalia), followed by five metacarpal bones (metacarpalia), and finally the five fingers (phalanges). A broken hand is a fracture in one or more of the carpal bones or metacarpal bones. There is also an article about broken fingers.

How does a broken hand occur?

A fall onto an outstretched hand is almost always the cause of a fractured carpal bone. In this situation, it is usually the scaphoid (os scaphoïdeum) that breaks.

A fractured metacarpal bone is more often the result of a hard blow on or with the hand. The end of the fifth metacarpal bone - the bone that leads to the little finger - is the most frequently broken. This fracture is often the result of a hard punch against a hard object such as a door or wall. Another term for this is therefore a ‘boxer's fracture’.

Another possible cause is reduced bone quality due to osteoporosis (bone loss) or bone cancer. The quality of the bone tissue decreases, causing bones to break more easily.

Characteristics of a broken hand

Characteristics of a fracture of one or more metacarpal bones are:

• Sharp (pressure) pain.
• Localized swelling.
• Possible deformity that is visible as a depressed knuckle or shortened finger.
• Increased pain with finger movements or when making a fist.

A fractured carpal bone usually causes (pressure) pain and localized swelling or bruising near the fracture. Which carpal bone is broken determines other symptoms. For example, with a scaphoïd fracture, movements of the thumb and wrist are also painful.

How is a broken hand diagnosed?

The general practitioner or physical therapist will take a history and perform a physical examination. The hand is examined and checked for deformity, swelling, or discoloration. Then the mobility and muscle strength of the hand are tested.

Testing for axial compression pain is performed for suspected fractures in the hand or fingers. Here the doctor carefully presses each finger one by one in the direction of the hand. In a fractured metacarpal bone or carpal bone, this test immediately increases the pain.

To further assess the severity of a fracture, röntgenfoto’s are taken in the hospital. These images show the bone fragments from different directions. If the doctor deems it necessary, a bone scan may also be performed. This scan provides more clarity about bone quality.

Treatment of a broken hand

For a broken hand, there are two types of treatment: with surgery or without surgery. Where possible, a surgeon chooses not to operate.

Conservative management, which means without surgery, usually begins with a casting period of 3 to 4 weeks. After the cast is removed, rehabilitation with physical therapy begins.

Mobility, strength, and function of the hand must be trained. It may take several months for the hand to fully recover.

In the case of an open fracture, where a piece of bone protrudes through the skin, surgery is necessary. Another reason to perform surgery is a fracture in which the bone fragments are displaced. If the fracture heals insufficiently or in the wrong position during the casting period, surgery will still follow. During surgery, the surgeon fixes the bone fragments in the correct position with metal pins or screws and a plate.

Further recovery after surgery is the same as after a casting period. The difference is that recovery time after surgery is on average longer, in some cases up to a year after the operation.