It is a very recurrent type of injury among athletes and manual workers. When a fracture occurs, a loss of continuity of the bony or cartilaginous structure is generated as a consequence of a trauma or, in some cases, by a weight overload.
In the case of hand fractures, the most stable bone structures are the second and third metacarpal, while the first, fourth and fifth metacarpals provide a great capacity to rotate on their axes. This is important to know since the less mobile bones require optimal fracture reduction to ensure hand stability.
Classification of fractures
There are four types of fractures: closed, open, displaced and stable. Open fractures are the most complicated, since there is communication between the fracture site and the exterior through the wound, which increases the risk of bone infection. Furthermore, depending on the fracture line, they can be classified as transverse, longitudinal, oblique, spiral and comminuted, which are fractures in which the bone breaks into small fragments.
Most common fractures
- Plume fracture: consists of a fracture of the tip of the finger and does not usually require surgical treatment when closed.
- Bennett’s fracture is the most common fracture of the thumb. It is a fracture of the base of the first metacarpal and requires surgical intervention.
- Rolando’s fracture: it is a type of fracture of the base of the first metacarpal characterized by three fragments. It is treated surgically.
- Baby-Bennett or reverse Bennett fracture: this is a fracture of the fifth metacarpal that usually requires surgical treatment.
- Boxer’s fracture: again, affects the fifth metacarpal as a result of direct trauma and causes palmar angulation of the head.
- Scaphoid fracture: the result of hyperextension of the wrist usually following a fall on a hyperextended hand. The scaphoid is the most commonly injured carpal bone.
What can I do to treat the injury?
There are two types of treatment and the choice of one or the other depends on the characteristics of the fracture. Orthopedic treatment is used in cases of stable fractures, with little or no displacement, and which can be reduced by closed manipulation. The fracture is immobilized with the aid of a splint or closed cast.
While surgical treatment is applied in cases of open fractures that require cleaning of the fracture site or in those unstable or displaced fractures that are not reducible by manipulation. After the treatment and the first signs of bone consolidation, a period of physiotherapy is initiated to recover mobility.
Can complications arise after surgery?
Different complications can arise after surgical treatment, among them:
- Infection. It is very frequent in cases of open fractures, since they are exposed to contamination of the wound. In the most extreme cases, the infected bone is resected and replaced with healthy bone.
- Pseudarthrosis. Occurs when there is a failure in the union of the fractured fragments. It causes chronic instability and painful mobilization. To solve it, bone grafts are used to fill the fracture.
- Vicious consolidation. It appears when a bony fall is formed in an incorrect position. It is accompanied by pain and alteration in the stability of the hand. It requires surgical treatment to solve it.
- Deficit of movement. Despite successful surgical intervention, subsequent complications may occur due to the complexity of the fracture or injuries associated with the initial trauma.