Fractures of the bones of the hand can run a wide range of degree of severity, forms of treatment, and the lengths of time required for recovery. Open fractures such as crush injuries to the fingertips usually require immediate care to avoid infection to the injured bones. These injuries can usually be easily managed in an office setting. More complex fractures require outpatient surgery to reduce the fractures and provide proper stabilization. Two techniques are commonly used. Closed reduction of the fracture can often be performed under x-ray guidance without the need to open the skin and perform a larger surgical procedure. After successful closed reduction, the broken bones are stabilized, often using percutaneously placed stainless steel wires called K wires. These temporarily placed stainless steel wires are easily removed when the bones have healed.
Open surgical reduction of a displaced fracture is required in more complex types of injuries. Although this may require a more extensive initial surgical procedure and the placement of permanent internal titanium plates and screws, patients can experience rapid recoveries due to the ability to start the patient on early active range of motion programs. The ability to allow the patient to move the injured extremity at a very early time prevents postoperative stiffness and discomfort.
One of the most common fractures of the hand, the “Boxer’s facture” is usually sustained from patients punching an object with their hand. The hand “metacarpal” bone proximal to the fourth or fifth finger is typically fractured below the knuckle and angulated in a volar or downward direction as a result of this injury. Fractures with minimal angulation can be treated with simple splinting techniques. More angulated fractures require surgical reduction and stabilization.