The hand and wrist are made up of many bones that form its supporting framework. The bones act as attachments for the muscles which make the wrist and fingers move. The shape and alignment of those bones allow you to bend, straighten, rotate and twist in order to use your hands for all daily activities.
A fracture occurs when there is enough force applied to a bone to break it, such as falling down on an outstretched hand and wrist or during a forceful, high impact activity. A fracture is the same as a broken bone.
As we get older, the bones may become more brittle with osteoporosis commonly making the hands and wrist more susceptible to breaks. A fracture may be simple with the bone pieces staying in alignment and good stability. Other fractures are unstable and the bone pieces have shifted out of place and there may be many small fragments. An open, or compound fracture results in the bone fragments breaking through the skin. That is most often due to a highly forceful injury and poses risks of infection and soft tissue structural injuries.
When a fracture occurs, there will be pain, stiffness and loss of movement. In some cases, there will be an obvious deformity, like a crooked wrist or finger. The finger may also appear shortened or may cross over another finger when you attempt to make a fist. However, often times there will be no obvious deformity and the individual will have some movement of the area. That may give you a false assumption that the body part cannot be broken.
Because of the close relationship between the bones, ligaments and tendons, the bone pieces may stay aligned and function is maintained with some degree of pain. That is often the case in a scaphoid fracture. The scaphoid is a bone in the wrist located on the thumb side of your hand. Many people with scaphoid fractures think they have a sprained wrist instead of a broken bone because there is no obvious deformity and very little observable swelling. Your doctor will use an X-ray to assist in determining how the fracture should be treated.
A splint or cast is used to treat a simple fracture that is not displaced or one that relocated. That will provide protection during the healing process. Other, more complicated and displaced fractures require surgery to put the bone pieces back into alignment and allow for good structural healing. That stability of the fracture may be achieved with placement of pins, screws and/or plates.
What to expect from therapy
Once the fracture is stabilized, you may be referred to a therapist to begin early rehabilitation of your hand, wrist and arm. It is not uncommon for you to begin therapy while your fingers and/or wrist are still in a cast. Early therapy intervention will help in reducing the long-term effects of a fracture including stiffness, pain, chronic swelling and loss of function in the hand and arm.
Therapy will include techniques to reduce pain and swelling, assistance and modification to splints/supports as the fracture heals and early movement exercises of the uninvolved joints such as the shoulder elbow and uninjured fingers.
As your healing progresses, your therapy will involve movement of the injured joint, stretching, scar and edema (swelling) management, and progressive strengthening and dexterity exercises to assist you in returning to normal use of your hand and wrist. The therapist may be helpful in determining modifications or assistive devices to allow you to perform your job or normal daily activities.
Your therapist may also make customized splints which help you to regain the mobility of your injured fingers or wrist. The therapist will also provide you with a home exercise program to help you achieve the best possible result following your injury.