Your hands are always in harm’s way. Whether it’s playing a sport, working in the kitchen, fixing a car, or just catching yourself after a slip and fall, your hands lead the way, and often take the brunt of the damage. Common types of hand trauma include
- forearm fractures (distal radius and distal ulna fractures)
- wrist fractures (scaphoid or other carpal bones)
- hand fractures (metacarpals and fingers)
- tendon and nerve lacerations
- sprains and dislocations
There are 29 bones in each wrist and hand, along with 34 muscles, 48 nerves, and 123 ligaments. There’s a reason that very large textbooks have been written just about the treatment of hand injuries.
Fractures and dislocations
A broken bone, or fracture, occurs when the bone is not strong enough to withstand the stress it is under. Unsurprisingly, different bones have different strengths. So it is much easier to break a finger than it is to break your forearm. Different bones also have different functions, so the treatments will also vary.
Forearm and wrist fractures
Forearm and wrist fractures are some of the most common fractures seen in an emergency room. The Colles fracture is a particularly common type of fracture of the distal radius bone, caused by a fall onto an outstretched hand. Most wrist fractures are closed, that is, the bone does not poke out of the skin when it breaks. Closed wrist fractures can be treated either with a cast or with a surgery, depending on what your X-rays reveal about the type of fracture you have. Open fractures of the wrist – that is fractures where the bone sticks out through the skin even for a second – are more urgent, and require surgery within a few hours of injury to prevent infection. Regardless, if you have a wrist fracture, it is very important to see a hand surgeon within a week of your injury – if surgery is necessary, it is best to do it within the first couple of weeks. A delay in surgery can make the operation more complex and prolong your recovery.
Fractures of the hand
You may have heard of the boxer’s fracture, which is a fracture of the metacarpal bone of the hand on which the small finger sits. Boxers don’t actually tend to get these injuries – usually they occur after punching something or someone with bad technique! These are often treated with just a cast or splint, although occasionally if there are multiple broken bones or the bones have moved significantly, a surgery may be required. Just as it is with wrist fractures, it is very important to see a hand surgeon within a week of injury. In many cases, the broken bones can be set into good position if it has not been too long after your injury – but a long delay can increase the likelihood of needing surgery.
Finger fractures tend to happen when fingers get twisted or crushed by falling objects or slamming doors. Many of these can be treated without surgery, but sometimes fractures that seem really minor may actually be more problematic than even a wrist fracture. X-rays and a good careful examination are always important in determining what type of treatment is necessary for a finger fracture.
Dislocations
Dislocations occur when a bone slips out of its joint, and doesn’t slip back in. Bones normally stay in their joints because of strong tissues that hold the bones in place – these are called ligaments. When dislocations occur, it usually results in one or more ligaments being torn in the process. Dislocations can be very deceiving –
even if the finger has been popped back into place immediately after the injury, the ligament may still be torn and some physical therapy, splinting, or even surgery may be required.
How are fractures and dislocations treated?
A broken bone or a torn ligament takes around 6 weeks to heal. No treatment changes the amount of time it takes for tissues to be fully healed. However, the hand surgeon’s job is to make sure that these tissues heal in an appropriate position and that you get the right rehabilitation of your hand. A bone that heals in a bad position can cause a problem with the alignment of your joints, leading to post-traumatic arthritis, chronic pain, stiffness, or difficulty with movement and use of your hand. There are a few types of treatment options for fractures and dislocations.
Casting
A cast holds the bone in position and prevents you from being able to move the joints above and below the broken bone. This just gives the bone time to heal without being moved around. As you can imagine, the cast has to stay in place until the bone is healed, so this is usually for around 6 weeks.
Reduction and casting
Sometimes the bone is in a bad position, but by pushing on it or pulling on it, it can be moved into a good position – this is called a reduction. This requires your hand to be numbed with an anesthetic injection so that the process will not hurt. After reduction, a cast has to be placed to hold the bone in its new, good position.
Surgery
Surgery comes in many flavors. It can involve hidden permanent titanium plates and screws, temporary pins to hold the bones while they are healing, or even an external scaffolding to hold the bones in place for more significant fractures. The right surgery for you will depend on a wide variety of factors, and Dr. Nagarkar will discuss all of these with you.
Therapy
Hand therapy is actually the most important part of any treatment plan for hand injuries. Regardless of your treatment, therapy is critical to get full motion and strength back. A certified hand therapist can help you through the process, and Dr. Nagarkar communicates closely with your therapists to ensure that you are getting the most appropriate therapy regimen for your injury.
Dr. Nagarkar on hand and wrist injuries:
Repairing bones, tendons and nerves is a marriage of medicine and engineering. Many of the technical issues we have to think about and solve are not that different from fixing a broken table or rewiring your media room. It’s just that the parts are a bit smaller, the instruments much finer, and the end result is not just a better surround sound system, but a hand that works well for the rest of your life.
Tendon, nerve and blood vessel injuries
Injuries to tendons, nerves, or blood vessels are relatively intuitive to think about: if one of these structures is cut, a surgery will generally be needed to reconnect the two ends back together! This isn’t too far from the truth, although it can get a bit complicated depending on where exactly the injury has occurred and which structures are involved. Moving the injury a half inch in any given direction can make a huge difference in the type of surgery you need, or the type of physical therapy you need. Occasionally a microscope may be necessary to perform the repair, using suture threads that are practically invisible to the naked eye. A comprehensive and careful examination is critical in determining exactly what the surgical and post-surgery rehabilitation plans should be.
To meet Dr. Nagarkar in person, schedule your consultation or call us.