Hand and Finger Fractures

What are hand and finger fractures?

The hand contains 27 bones, all of which can be fractured. Most hand fractures happen as a result of direct trauma - falls, sport, crush injuries, punch injuries, or workplace accidents.

Many hand fractures heal well with splinting or casting alone. Some require surgical fixation to realign the bones, particularly when the fracture is displaced, unstable, intra-articular (involves the joint), or rotationally malaligned (which causes the finger to overlap others on making a fist).

Common fractures

• Metacarpal fractures - including the very common “boxer’s fracture” of the little finger metacarpal
• Phalanx fractures - fractures of the finger bones, often from a crush or twisting injury
• Intra-articular fractures - fractures extending into a joint surface; often require fixation to restore the joint surface
• Carpal fractures - fractures of the small wrist bones (scaphoid fractures are covered on a separate page)

Diagnosis

Most hand fractures are diagnosed from examination and plain X-rays. CT scans are occasionally used for complex intra-articular fractures or when X-rays are unclear.

Non-surgical treatment

Many hand fractures heal reliably with:

• Splinting or casting for 3-6 weeks, depending on the fracture
• Buddy taping (strapping an injured finger to an adjacent healthy one) for stable phalanx fractures
• Early hand therapy for stiff but stable injuries

A high volume of hand fractures are managed non-surgically through the close referral relationship between Aspire Orthopaedics and NQ Hand Care Clinic, whose plaster technicians and hand therapists are available at the same North Ward location.

Surgical treatment

Surgery is considered when:

• The fracture is significantly displaced
• The fracture is unstable and will not hold position in a splint or cast
• The fracture extends into a joint surface and requires anatomical reduction
• There is rotational deformity of the finger
• There are multiple fractures, or associated tendon or nerve injuries

Fixation techniques include percutaneous pinning (wires passed through the skin into the bone), screws alone, or plate and screw fixation for more complex injuries. The choice depends on the fracture pattern.

Surgery is performed at Townsville Day Surgery or Mater Hospital Pimlico, under regional block with light sedation. Most are day procedures.

Recovery

Recovery varies with the fracture and the fixation method, but in general:

• Weeks 0-4 - protection in a splint or cast; gentle finger movement encouraged in protected positions
• Weeks 4-6 - transition out of rigid immobilisation into a custom removable splint; hand therapy intensifies
• Weeks 6-12 - progressive strengthening and return to most activities; desk work early, manual work typically 6-12 weeks
• Months 3-6 - final grip, pinch, and fine motor recovery

Hand therapy is central to a good outcome and is available through NQ Hand Care Clinic at the same North Ward location.

Risks

• Stiffness - the most common complication after hand fractures, minimised with early hand therapy
• Malunion - healing in a slightly imperfect position; occasionally requires further surgery if functionally significant
• Non-union - failure to heal; uncommon
• Tendon irritation from hardware - occasionally requires removal of pins or plates after the fracture has healed
• Infection - rare
• Nerve irritation, complex regional pain syndrome - rare but recognised