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When force is applied to a bone, it bends only a little and then breaks. This is called a fracture (a "fracture" is synonymous with a "break"). There are several types of fractures. In a non-displaced fracture, the bone cracks with the broken pieces still in alignment. The injury is not visible from the outside, but shows up as a line or crack on a x-ray. In a displaced fracture, the bone breaks in two or more pieces that have moved out of alignment. The distortion is visible from the outside and the break often causes severe pain. In an open fracture, commonly called a compound fracture, the ends of the bone are displaced, visibly piercing the skin. In these cases, there is a significant risk of infection.
Basically a fracture, which can involve any bone in the body, occurs when a strong force puts more stress on a bone than it can bear. Bones break differently depending on their structure and composition as well as the amount and type of force they are subjected to and the amount of energy they absorb prior to breaking.
Fingers can be fractured by direct injury, i.e. jamming, hitting or crushing them, or by being twisted suddenly. Two of the most common fractures of the wrist are fractures of the distal radius and the scaphoid, one of the small bones of the wrist, which are often caused by falling on the hand.
After an injury, there may be pain, tenderness, stiffness, loss of movement and usually swelling in the affected area.
With a medical evaluation and X-rays, a physician can usually tell if there is a fracture, what type of fracture it is, and what treatment is best. The physician will take into account the location of the fracture, to what degree the bone is shattered, the amount of displacement, whether the adjacent joint surface is involved, or if the overlying muscle, fat and skin are disrupted, as in an open fracture. All of these facts help determine the best course of treatment.
If a fracture extends into a joint, it must be carefully assessed with x-rays to determine if there is any significant change from the normal position of the joint surface. Fractures involving the joint may lead to early arthritis.
Occasionally, an accurate assessment of the amount of displacement cannot be made with routine x-rays, and special radiological studies must be obtained in the form of a CT scan or tomograms. These studies still require the use of radiation to generate the images, but the detail in hard-to-see locations is much better than with conventional x-rays.
Broken bones must be moved into position (set) and be prevented from moving out of place until they are healed. During the healing process, the body repairs and replaces the damaged bone. Most fractures heal in four to 12 weeks, varying by age (children heal faster than adults) and type of injury. Open fractures are an emergency which require prompt surgery to cleanse the wound and remove any irreversibly traumatized tissue in order to reduce the risk of infection.
To prevent the bones from moving out of place, a splint or cast may be used to treat a non-displaced fracture or a displaced fracture which has been set. Other displaced fractures may require closed reduction and internal fixation--wires and pins that hold the fracture in place without the need for an incision.
Some fractures may require surgery in order to set the bone--which is then held together with various combinations of pins, plates or screws. External fixators may be used to hold a set fracture together until the break heals. These are a set of metal bars which are placed outside the body and attached to pins fixed to the bone above and below the fracture.
Occasionally, a fracture may not mend or may mend more slowly than expected. In these cases, surgery may be needed to treat the problem.
With hand fractures, the biggest problem following treatment is stiffness, which is more likely if the break is close to where the finger meets the hand. Sometimes to prevent this stiffness, a physician may recommend a gentle exercise program before the fracture is completely healed.
For wrist fractures, which are often treated with a below-the-elbow cast for four to six weeks, the forearm muscles gradually weaken from lack of use during bone healing. Therefore, when the cast is taken off, significant weakness has ensued, and the patient is predisposed to secondary tendonitis and muscle strain as they attempt to resume their routine activities. Following a physician's advice regarding the healing process and the return to activities is always the best bet.
