Clinical Presentations and Management of Common Hand Fractures Hand fractures are common injuries that can affect the bones of the wrist (carpal bones), palm (metacarpal bones), or fingers (phalanges). Each type of fracture presents with distinct clinical features and requires specific management strategies: 1. Scaphoid Fracture Clinical Presentation: • • • Location: The scaphoid bone is located near the base of the thumb on the radial side of the wrist. Symptoms: Pain and tenderness in the anatomical snuffbox (located between the tendons of the extensor pollicis longus and extensor pollicis brevis). Swelling and limited range of motion at the wrist may also be present. Complications: Scaphoid fractures are notorious for delayed union or nonunion due to poor blood supply. Complications include avascular necrosis of the proximal fragment. Management: • • • Immobilization: Initially, immobilization with a thumb spica splint or cast is recommended to stabilize the wrist and promote healing. Follow-up Imaging: Follow-up with X-rays or MRI may be necessary to monitor healing and detect complications. Surgical Intervention: Some fractures, especially displaced or unstable ones, may require surgical fixation with screws or pins to promote union and restore wrist function. 2. Metacarpal Fracture Clinical Presentation: • • Location: Metacarpal fractures commonly occur in the index and little fingers due to their greater exposure to trauma. Symptoms: Pain, swelling, and deformity of the affected finger. There may be tenderness along the metacarpal bone and pain with gripping or moving the hand. Management: • Immobilization: Immobilization with a splint or cast may be sufficient for stable fractures. • • • Reduction: Closed reduction may be performed for displaced fractures to restore alignment. Surgical Fixation: Surgery with pins, wires, or plates may be required for severely displaced fractures or fractures involving multiple metacarpals. Rehabilitation: Physical therapy to regain range of motion and strength in the hand and fingers is essential for optimal recovery. 3. Intra-articular (Joint) Fracture Clinical Presentation: • • Location: Intra-articular fractures involve the joints of the fingers or thumb, disrupting the smooth articulation between bones. Symptoms: Severe pain with movement, swelling, and joint stiffness. There may be crepitus (grating sensation) and loss of normal joint alignment. Management: • • • Closed Reduction: Attempted under anesthesia to restore joint alignment and stability. Open Reduction: Surgical intervention may be necessary to achieve anatomical reduction and fixation with screws, plates, or pins. Postoperative Care: Immobilization with a splint or cast followed by physical therapy to restore joint function and prevent stiffness. 4. Phalangeal (Finger Bone) Fracture Clinical Presentation: • • Location: Fractures can occur in the proximal, middle, or distal phalanges of the fingers. Symptoms: Pain, swelling, and deformity of the affected finger. Tenderness and pain with movement, especially during gripping or flexing. Management: • • • • Splinting: Immobilization with a finger splint or buddy taping (taping injured finger to an adjacent finger) for stable fractures. Reduction: Closed reduction may be performed for displaced fractures to realign the bone fragments. Surgical Fixation: Open reduction and internal fixation with pins or screws for complex or unstable fractures. Rehabilitation: Physical therapy to regain range of motion and strength, especially for fractures involving joints. Conclusion Prompt evaluation and appropriate management of hand fractures are crucial to minimize complications and restore hand function. Treatment strategies vary based on the location, severity, and stability of the fracture, with a goal of achieving optimal healing and functional outcomes for the patient. Close monitoring and rehabilitation play key roles in ensuring successful recovery and preventing long-term disability.