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Hand Injury : Fractures
The hand is a complex structure, frequently the source of sports, work, or recreation-related injuries. Refer to hand injury: (general), for a broader discussion of hand injuries. A hand fracture refers to a break in one of the metacarpal bones of the hand. These 5 bones, located between the wrist and fingers, are the primary support structure of the hand. The most likely way for a fracture of this type to
occur is demonstrated in the person who "punches a wall," putting force directly on the metacarpal bones. This common injury, known as "boxer's fracture," results in a fracture of metacarpal #5 (the bone in the hand just above the little finger). Common symptoms include swelling and pain to the hand. A bluish discoloration may be seen on the palm (hematoma). There is point tenderness over the #5 metacarpal. One may also notice the absence of the "knuckle" when making a fist. Evaluation will include examination for tenderness to palpation and the presence of deformity, indicating a fracture. Bone x-rays will be necessary. Attention must be paid to the patient's ability to move each finger, feeling, and blood flow. In the normal unfractured hand, when the hand is closed [with the palm up], the fingers should naturally point toward the thumb side of the wrist. In the case of severely displaced metacarpal fractures, one will see one finger "trailing off" in the wrong direction (usually #5). This strongly indicates the need for surgery to repair the fracture site so normal functionality can be restored to the hand. An Orthopaedic Surgeon will perform this type of surgery--often within several days after the fracture. Ice packs, elevation, rest, and splint immobilization is the mainstay of treatment.Acetaminophen, aspirin, or anti-inflammatory agents (ibuprofen) can help reduce pain. Your doctor will provide stronger pain medications, if needed.Uncomplicated hand fractures can be managed by a trained emergency physician,
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