Hand Fracture

A hand fracture is a broken bone in the long bones of the hand (metacarpals) or the small bones of the fingers (phalanges).

Hand fractures in children can result from falls, sports injuries, crush injuries and various other forms of impact that apply enough force to cause injury. Treatment will depend on the location of the broken bone, the age and development of your child, as well as the type of fracture.

Fractures may be described in several different ways:

• Simple fracture (sometimes called a closed fracture): A bone breaks into two pieces but does not break the skin or damage surrounding tissue.
• Complex fracture (also called a compound or open fracture): A bone is broken into several fragments, soft tissues are damaged, and at least part of the bone protrudes through the skin.
• Complete fracture (sometimes called a displaced fracture): A bone is separated into two or more pieces.
• Partial fracture (also called a nondisplaced fracture): A bone is cracked but not broken in two, such as a hairline fracture.
• Intra-articular fracture: A fracture that crosses the surface of a joint and results in some cartilage damage.
• Extra-articular fracture: A fracture that does not extend into the joint.
• Physeal fracture: Childhood fracture that involves the growth plate of a bone.

Children’s bones are different than adults’ bones. They are softer and do not break in the same way an adult’s bone breaks. Bones that are bent but not broken often straighten out as they heal.

Your child can sustain a hand fracture when enough force is applied to the bone to break it. It can occur when a child falls onto his hand, the hand becomes twisted or is smashed, or your child hits — or is hit by — something very hard or heavy. A common cause of hand fractures in toddlers and young children occurs when the tips of their fingers are accidently caught in a closing door.

Symptoms of a hand fracture may include:

• Pain
• Swelling and bruising
• Tenderness
• Inability to move a finger
• Limited use of several fingers or part of the hand
• Misshapen or crooked appearance, or abnormal position (misalignment) of the affected finger(s)
• Weakness in the hand or fingers
• Depressed knuckle

Diagnosing a hand fracture typically begins with a physical examination of your child’s hand and fingers. Clinicians will check the position of the fingers and the condition of the skin.

In most cases, clinicians will recommend X-rays of your child’s hand. X-rays produce images of bones and can identify the location and extent of the fracture.

At Children’s Hospital of Philadelphia (CHOP), we use a variety of diagnostic tests to correctly identify the broken bone and the type of fracture. Accurate diagnosis helps us determine the best course of treatment.

In addition to a physical exam and X-rays, your child may also undergo:

• Range of motions tests to determine how the injury is affecting movement and dexterity
• Nerve assessment tests to determine if the injury has damaged or compressed any nerves

Treatment for your child’s hand fracture will depend on the location of broken bone, type of fracture, as well as the age and development of your child.

Nonsurgical treatment

Most fractures in children are simple fractures, meaning one bone has broken into two pieces and no damage has been done to surrounding tissues. Treatment for simple fractures is generally a splint or cast that covers part of the fingers and both sides of the hand and wrist. The cast or splint will help keep your child’s bone in one position so it can heal together correctly.

Your child’s doctor will provide instructions about the splint or cast including:

• When your child can start moving their fingers around while wearing the splint or cast
• Instructions for covering the cast, or when your child can remove the splint, to take a shower or bath
• When your child can remove the cast or splint and begin using their hand normally

Surgical treatment

If your child has a complex hand fracture that affects the metacarpal bones or alters the alignment of her fingers, your child will be referred to an orthopaedic surgeon.

The goal of surgery for a hand fracture is to stabilize and align the bones. This may include implanting screws and plates into the broken bone to keep it in place.

After surgery, your child’s hand will be placed in a cast that will immobilize the hand while the bone heals.

Surgical safety

Though surgery for hand fractures is highly effective, we understand that any surgery can be a stressful experience for children and families. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

Follow-up care for hand fractures will depend on the treatment needed. Children with simple fractures that required bracing with a splint or cast will be able to resume regular activities more quickly than those who needed surgery.

Children with complex fractures who needed surgery will need to wear a hand cast for three to six weeks. When the fracture is healed enough to be stable, your child will be encouraged to begin motion exercises to avoid stiffness and regain range of movement. Depending on the complexity of your child’s hand fracture, physical therapy may also be recommended.

Hand fractures are temporary conditions. Once the splint or cast is removed, there are generally no complications and your child can resume an active lifestyle.