Hand and Finger Fractures: Overview

Hand and Finger Fractures: Overview

The hands and fingers are made up of many small bones. These include the 5 long bones of the hand called the metacarpals, and the finger bones called phalanges. The thumb has 2 phalanges, the proximal phalanx and the distal phalanx, while all other fingers have 3 phalanges, the proximal, middle, and distal phalanges. Injuries to the hands and fingers can cause fractures in any of these bones.

The 5 metacarpal bones of the hand are divided into different regions. The end of each bone closest to the fingers is called the head, the middle portion is called the shaft, the area between the head and the shaft is called the neck, and the other end closest to the wrist is called the base. The neck is the most common place to have a metacarpal fracture, which occurs most often in the ring and pinky fingers. A metacarpal neck fracture of the fifth metacarpal that connects to the pinky finger is called a boxer's fracture because a punch with a closed fist often causes this injury.

Fractures that affect the first metacarpal that connects to the thumb include a Bennett fracture and a Rolando fracture. These fractures are often displaced, causing the thumb joint to shift out of normal alignment. The majority of metacarpal fractures are closed, simple, and stable. However, fractures can also be open, where the bone breaks through the skin, complex, and unstable. Metacarpal fractures make up 40% of all hand injuries and most often occur in males in their teens and 20s.

Causes of metacarpal fractures include a direct blow to the hand, typically through punching an object, a sports-related injury, rotational stress, and high-energy trauma such as a car accident, which will likely result in multiple fractures. Like the metacarpals, the phalanges are similarly divided into the head, neck, shaft, and base. Finger fractures can occur in a variety of different patterns. They are most commonly spiral or long oblique in the proximal phalanx, or first finger bone, and short oblique or transverse in the middle phalanx, or middle finger bone.

Finger fractures are common work-related and athletic injuries, and most often occur in males in their 20s. Common causes include a fast-moving ball hitting the hand, slamming the fingers in a door, and direct impact from using hammers and power tools. Symptoms of hand and finger fractures include pain, swelling, bruising, and tenderness. Range of motion of the fingers is often limited and painful, preventing the fingers from fully bending or straightening. The fingers or knuckles may also look deformed if the bones have shifted out of normal alignment.

To diagnose a hand or finger fracture, a health care provider will examine a patient's hands and fingers and look for signs of trauma, uneven finger length, uneven knuckles, and whether the fingers overlap. When bent, all fingers should point down toward the thumb side of the wrist. The fingers will be examined in both straightened and bent positions to check their alignment and range of motion. An x-ray is the best way to determine if there is a fracture. X-rays will be taken in multiple planes to be able to view all sides of the metacarpals and phalanges.

X-rays will also help a health care provider determine the location of the fracture and whether the type of fracture is spiral, oblique, or transverse based on the direction of the break in the bone. Severe fractures, called comminuted fractures, occur when bones shatter into many pieces. Other things that a health care provider will look for on an x-ray include the angle of the hand and finger joints, rotational alignment or overlapping of the fingers, and shortening of the bones. A health care provider will then use these findings to determine what type of treatment is needed in order for a hand or finger fracture to heal.