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This article will review the symptoms, causes, and management of a broken hand. Symptoms include pain, tenderness and swelling over the site of the injury, an inability to move the hand or fingers, and surrounding numbness or tingling.
Hallmarks of a broken hand?
A broken hand, or a hand fracture, is defined as a break in any of the bones in the hand. The specific bones in the hand include the carpals (eight small bones that make up the wrist), the metacarpals (five bones in the palm of the hand), and the phalanges (a set of bones that make up the fingers). Most hand fractures are caused by some form of physical injury.
Symptoms of a broken hand include pain, tenderness and swelling over the site of the injury, a possible open wound, deformity of the hand, an inability to move the hand, and surrounding numbness or tingling.
Possible treatment includes splinting, ice, the cleaning and closure of any wounds, antibiotics, reduction for displaced fractures, pain medication, as well as surgery and physical therapy.
You should seek immediate medical care at an ER, where doctors can decide whether to get x-rays, which would recognize a fracture. Treatment would involve splinting temporarily, but if it's severe, surgery to re-align the bones.
Symptoms of a broken hand
The main symptoms of a broken hand may include the following.
- Pain, tenderness, and swelling over the site of injury: These are the most common symptoms. Bruising may be seen over the site of the injury as well.
- Open wound over the site of the injury: If the hand fracture was caused by a significant injury, an open wound may be seen over the site of the injury. This is important because an open wound increases the risk of infection and requires specific treatment to reduce the risk of infection.
Some cases of a broken hand may present with the following.
- Deformity of the hand or fingers: These are usually seen in more substantial injuries in which the bones are displaced from their normal position.
- Inability to move the hand or finger: This can happen if the fracture is displaced in such a way that prevents the joints from normally bending, but may also be due to an injury to the nerve that provides normal motor function.
- Numbness or tingling in the hand or finger: Some cases of hand fractures may be associated with numbness or tingling in the hand or finger. This is a concerning sign, as this suggests that damage has been done to the nerves.
Broken hand causes
The specific mechanism of injury may be associated with breaks in specific bones of the hand. Examples of common injuries are detailed below.
Direct trauma to the hand or thumb
Direct trauma to the hand may result in fracture, such as the following scenarios.
- Falling onto an outstretched hand: Falling onto an outstretched hand with the hand extended back may cause a fracture of one of the carpal bones, most commonly the scaphoid bone, which is located near the base of the thumb.
- Trauma to the palm of the hand: This may cause a fracture of one of the metacarpal bones. These fractures account for 30 to 40 percent of all hand fractures.
- “Jamming” the thumb: An injury that jams the thumb, such as falling onto an outstretched thumb or hitting the thumb against a hard surface, can cause a fracture of the metacarpal of the thumb.
Trauma to the fingers
A broken hand may result due to damage to one or more of the fingers, such as the following.
- Trauma to or hyperextension of the fingers: Bending the fingers back farther than they normally bend can cause a fracture of the phalanges.
- Sudden forced flexion of the tip of the finger: A sudden, forced flexion of the tip of the finger, which is typically seen in collision sports or ball-handling sports, can result in a specific type of injury called a “mallet finger.” This is an injury of a tendon at the tip of the finger that is often associated with a fracture of the tip of the finger.
- Sudden forced extension of the tip of the finger: A sudden, forced extension of the tip of the finger, which is typically seen when the finger gets caught on something such as a shirt or jersey, can result in a specific type of injury called a “jersey finger.” This is an injury of a different tendon at the tip of the finger that is often associated with a fracture of the tip of the finger.
Repetitive stress to any of the bones in the hand, which may be seen in athletes or people whose occupations require the use of their hands may result in stress fractures of the hand.
Treatment options and prevention for broken hand
The specific treatment for a hand fracture depends on the location and type of fracture, so a complete examination and imaging are important components of the evaluation. Specific treatment options include the following.
Treatment of open wounds
If your hand fracture is associated with an open wound, it should be washed out with sterile saline solution and covered with clean gauze. If you must clean the wound yourself, you should seek the care of medical professionals as soon as you can. You may then receive a course of antibiotics to reduce your risk of infection, especially if the fracture is associated with an open wound. Possible antibiotics that may be given include cefazolin (Ancef), vancomycin (Vancocin), or ceftriaxone (Rocephin), among others. The antibiotics are usually continued for 48 to 72 hours or for 24 hours after the wound is closed.
Reduction for displacement
If a hand fracture is displaced, meaning the bone fragments have been displaced from their usual position, the fracture may need to be reduced so that the bone fragments are restored to their normal positions.
Ice, elevation, and splinting
Details regarding ice, elevation and splinting can be found below.
- Ice and elevation: Shortly after the injury, applying ice to the site of the injury and keeping the hand elevated can reduce swelling and aid in healing and comfort.
- Splinting: Almost all hand fractures will need to be placed in a splint to reduce movement for the bones to properly heal. For a displaced fracture, you will receive a splint after the fracture has been reduced. Your splint will likely span the two joints on either side of the fracture, and be placed in such a way to counteract the normal movements of the joints. The splint will usually be kept on for three or more weeks, although your doctor may recommend that you start exercising the hand after seven to 10 days of immobilization.
You may require pain medications, and usually, your doctor will recommend over-the-counter medications such as acetaminophen (Tylenol). Your doctor may recommend avoiding nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve), since these may interfere with the healing process. In cases of uncontrolled pain, a short course of opioid medications may be prescribed.
Procedures and physical therapy
Possible procedures and physical therapy are detailed below.
- Procedures: Some hand fractures may require surgery to repair the fracture and surrounding tissues, depending on the severity of the injury. The evaluation will usually be done by an orthopedic surgeon, who will determine the need for surgery. Surgery is usually recommended for displaced fractures that cannot be safely reduced, or in cases where the nerves or blood vessels are damaged.
- Physical therapy: In order to recover effectively and restore function to your hand, it will likely be necessary to undergo physical rehabilitation during and after a period of immobilization. Physical rehabilitation with an occupational or physical therapist can improve recovery and reduce the risk of long-term disability. Physical rehabilitation will usually last for several weeks.
When to seek further consultation for a broken hand
If you experience any symptoms of a broken hand after a hand injury, you should go to your doctor or to the emergency room to determine if you have actually suffered this injury. This is especially important if you experience any numbness or tingling or an inability to move the hand, as this may indicate an injury to the nerves or blood vessels that needs to be promptly treated.
Questions your doctor may ask to determine broken hand
- Where is your hand area swelling?
- The redness affects one hand or both hands?
- Which part of your hand hurts?
- How would you describe your hand pain?
- Do you have a rash?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Liu received his medical degree from the University of Pennsylvania Perelman School of Medicine and is pursuing a career in ophthalmology. He graduated Phi Beta Kappa from Swarthmore College with a BA in biology. He has published research in multiple ophthalmology and healthcare journals and has received awards from Research to Prevent Blindness. In his free time, he enjoys running, biking, and spending time with his friends and family.
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