A fracture is the medical term for a broken bone. The hand and wrist are made up of many small bones with complex movements needed for a wide variety of daily living and work activities including eating, grooming, using a computer, and using power or hand tools. The most common fracture in the wrist is the radius, the larger of the two bones in, the lower part of the forearm. Fractures of bones in the hand, especially those in the fingers, are the most common of all fractured bones treated in emergency departments. Fractures may be categorized as undisplaced or displaced. Undisplaced fractures, also called hairline fractures, are in perfect position and likely to heal without problems. Displaced fractures usually need to be reduced, or have their positions corrected either by pressure or traction in specific directions - or by surgery to physically correct the bone position.
Two categories of fractures are particularly problematic: intra-articular fractures and open fractures. Intra-articular fractures are fractures within a joint. If left to heal on their own, they can cause rough joint surfaces which can later lead to arthritis. Open fractures are fractures in which the skin has been broken. Fractures of this type can lead to much higher likelihoods of infection.
Diagnosis is made through a physical examination and x-rays. An undisplaced fracture remains in proper alignment, but symptoms may still include pain and swelling. Displaced fractures include those symptoms, but also, the area of the break is deformed. Other symptoms include increased pain with motion on the broken part. Fractures may be stable and require only a splint, or unstable and require a cast or surgery. This is often a difficult decision which should usually be made by a specialist orthopedic hand surgeon. Surgery may involve placement of pins, plates or screws to hold the position until the broken bone heals. Such secure fixation is important to allow early motion and avoid stiffness, which can be a very significant problem in treating fractures in the hand and wrist.
A number of factors must be taken into account. Someone who works in a job that requires heavy lifting or fine manipulation might need different care than someone confined to a wheelchair with limited hand use. The type of fracture, patient age, and overall health can also affect treatment choices.
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