Broken hand bones Kōiwi tāwhatiwhati o te ringa

The ends of each of your metacarpal bones form joints at:

• one end with the small bones in your wrist (carpal bones)
• the other end with the small bones of your fingers and thumb (phalanges).

Your metacarpals can break in different places, such as the head, neck, shaft or base.

Types of break (fracture) with a broken hand bone. Fractures are at the head, neck, shaft and base of the metacarpals.

Some breaks are more serious than others, depending on:

• how many pieces the bone breaks into
• whether the break involves a joint
• whether or not the broken ends are still together.

You can break your metacarpal bone if something hits your hand or your hand hits something. If the stress is too great, you can break one or more of them.

If your hand is swollen, tender or painful, or out-of-shape (deformed), you may have broken it.

Other things you might notice are:

• you might not be able to move a finger
• one of your fingers may seem shorter or cross over the next finger when you make a partial fist
• a knuckle may seem sunken, or less prominent.

If you think you may have broken a bone in your hand, it is important to see a healthcare provider.

They will examine your hand and ask questions about what happened. You will also have an x-ray to show which bone is broken and how it is broken.

X-rays

Treating a broken hand depends on what the break looks like. Most are simple, with the ends of the broken bone still together. These are treated with a splint or cast, but no surgery.

If the broken ends of the bone are not aligned, your healthcare provider may need to move them back into place. This does not usually need surgery, but you will probably get a local anaesthetic injection to numb the area or be given laughing gas (nitrous oxide).

You will have a splint or cast to stop the bones in your hand from moving. The cast or splint will probably extend from below your knuckles, over your wrist and almost to your elbow. This makes sure the bones stay in place. It is important to care for your cast, so it continues to protect your hand.

Care for your cast

You will wear the cast or splint for 4 to 6 weeks. You will probably be able to start doing some gentle hand exercises after 3 weeks.

Hand exercises while your arm is in a cast

When the cast comes off, the finger above the bone you broke may be slightly shorter than before. This should not affect your ability to use your hand and fingers.

You will also need to take special care of your hand for a while after your cast comes off, including doing some strengthening exercises.

Care of your wrist and hand after a fracture

There are several things you can do yourself to help your hand heal, whether or not you are having surgery.

• If you smoke, stop smoking. Smoking slows the healing process.
• Do not do any heavy lifting or gripping with the injured hand, as this will cause pain and slow your recovery. You may need some time off work to let your hand recover.
• Avoid putting pressure or force on your hand while it is in a cast or splint. If you do, you may not heal quickly or well.
• Take regular pain relief as recommended by your healthcare provider. Seek advice from your healthcare provider if you still have pain while taking the recommended pain relief. Do not take extra pain relief that has not been prescribed for you.

Pain relief medicines for adults

If you need surgery, it will be done by an orthopaedic (bone) surgeon or a plastic surgeon.

The surgery you have will depend on the type of break. Your surgeon will discuss this with you, including the risks, benefits and expected recovery.

Whatever surgery you have, it will involve inserting some metal (a plate, screws or possibly wires) to align your bone properly and support it while it heals.

Surgery usually involves spending a night in hospital, and your hand will be in a splint or cast for up to 6 weeks.

Recovering after surgery

You will need at least 2 weeks off work after surgery. You may need longer if:

• the break is in the hand you use most (your dominant hand)
• your job involves manual or heavy physical work (there may be light duties you can do).

You will not be able to carry or lift anything for about 2 months.

You will need to see a hand therapist for advice and exercises to strengthen your hand and get it moving again.

As you recover, you will have regular appointments with your surgeon and some x-rays to make sure your hand is healing well.

If wires have been placed into your broken hand bone, they may be buried under your skin or they may be poking out from the end of your knuckle. They will probably have to be removed.

If they are poking out from your knuckle, they will be removed at a clinic appointment. This is not usually painful, but it is a good idea to take some pain relief before you come to this appointment. If they are under your skin, you may need another operation to remove them.

Self care after surgery

While you are recovering, you should avoid:

• lifting or carrying anything on your injured side
• any sport or other activity that could make your injury worse.

Your surgeon will let you know when it's safe to do these things again.

If wires are poking out from your knuckle, it is important to protect them so they do not get caught on clothing or are accidentally pulled out. If this happens, it can be painful. You may also need more surgery to put them back in, which can affect how well you heal and how well your hand works in the future.