Fractures of the bones of the hand are common and can have significant impact on function both in the short and long term. I am often told in the rooms that “oh well, it’s just a finger” or that “there’s nothing they can do about finger fractures anyway” and to be honest nothing could be further from the truth.
While many fractures in the hand can be managed non-operatively with simple measures such as splinting or buddy taping, there are a number of injuries that are best managed with surgery. Early specialist assessment will ensure that you optimise the outcome of your injury.
Hand therapists play a very important role in the management of hand injuries. Managing swelling and pain in the early stages and guiding safe, early mobilisation of injured hands are key aspects of the care provided. Your surgeon and therapist will work together to create an individual plan, tailored to your injury to ensure the best possible result.
The concept of managing hand injuries is quite simple – get the hand moving again as soon as possible. Some fractures around the hand are inherently stable and movement can be commenced as soon as comfort allows (usually within 1-2 weeks). Unstable injuries may be best managed with surgery to provide stability such that motion can begin early in the post-operative course. Either way, you should be getting your hand moving again within two weeks of injury – prolonged immobilisation can be very difficult to recover from.
Surgery for Hand Fractures
The aim of surgery for fractures of the hand is to stabilise the fracture back in its normal position such that you are able to start moving the hand straight away. Fractures can be fixed with any combination of simple pins (K-wires), plates and screws and these days there are a number of implants specifically designed for various hand fractures.
Following surgery your hand will most commonly be placed into a temporary half-plaster (back slab) designed to allow your hand to rest in a functional position and encourage early wound healing and resolution of post-operative swelling. You will be referred to see a specialist hand therapist usually within 3-5 days of surgery to have this back slab taken off and to start your rehabilitation. Sometimes this will involve the application of a custom-made, removable splint designed to protect your hand in the early stages. Your therapist will ensure you have a good understanding of what exercises and activities you should be doing as well as what you shouldn’t be doing as you recover.
In general, with or without surgery, fractures will take approximately 6 weeks to heal to the point that no further protection is required to return to day-to-day activities and 3 months to heal to the point that all activities (contact sport, manual labour) can be resumed. Dr Alexander and your hand therapist will tailor this advice to your individual injury and rehabilitation progress. It can take 3-6 months for swelling and stiffness to completely resolve after significant hand injuries or surgery, so don’t be surprised if it takes this long to feel like you have completely recovered.