Our hands are vital for many of our daily tasks. Industrial, recreational and home accidents often result in dislocations, fractures, lacerations, bums and amputations. Because the fingers and hands are required to function in such intricate ways, any injury that is not treated properly may result in permanent disability, as well as deformity. For this reason, most hand injuries should be evaluated promptly by a physician.

Fractures of the hand bones (metacarpals) account for about one-third of all hand fractures. In fact, fractures of the fifth bone (the one that leads to your little finger) are commonly known as "boxer's fractures."

The hand bones can break near the knuckle, midbone or near the wrist. Signs and symptoms of a broken bone include:

Swelling

Tenderness

Deformity

Inability to move one or more fingers

Shortened finger

Depressed knuckle

Finger crosses over its neighbor when you make a partial fist

How do you treat a broken bone in the hand?

1. Cover all wounds with a dry, sterile dressing.

2. Form the injured hand into the position of function, that is, with the fingers moderately flexed or curved as though holding a softball or a can.

3. Place a soft roller bandage or similar cloth into the palm of the hand.

4. Apply a padded board or other rigid material to the palm side of the wrist, and secure the entire length of the board with a soft roller bandage.

5. Prop the splinted hand and wrist on a pillow or on the victim's chest during transport to the hospital.

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A physician will likely request X-rays to identify the fracture location and type. The physical examination may include some range-of-motion tests and an assessment of sensation in the fingers to ensure that there is no damage to the nerves.

Most of the time, the physician can realign the bones by manipulating them without surgery. Then a cast, splint or fracture-brace is applied to immobilize the bones and hold them in place. The cast will probably extend from the fingertips down past the wrist almost to the elbow to ensure that the hand bones remain fixed in place. The physician will probably request a second set of X-rays about a week later to ensure that the bones remain in the proper position. The cast will likely need to be worn for three to four weeks, but the patient can probably begin gentle hand exercises after three weeks. Afterward, the finger may be slightly shorter, but this should not affect the patient's ability to use the hand and fingers.

Some hand fractures, such as those that break through the skin or result from a crushing accident, may require surgery to stabilize and align the bones. The orthopedic surgeon implants wires, screws or plates in the hand to hold the fracture in place. If the bone rotates while healing, loss of function could result.

After the bone has healed, the surgeon may remove the implants, or they may be left in the hand. Research to develop implants that are reabsorbed into the body is ongoing. The physician may ask the patient to return frequently for check-ups to ensure that the joint doesn't tighten (contract) during healing. The patient may experience some joint stiffness because of the long immobilization period. The physician may prescribe exercises to help restore strength and range of motion or recommend that the patient see a physical therapist.

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