WHAT YOU SHOULD KNOW
The small bones of the hand are easily broken and often shift out of place. The two main issues are to prevent deformity and loss function due to healing in the wrong position and to also prevent stiffness.Most of the stiffness comes from the injury itself, but treatment choices must be considered since the more invasive the treatment, the more final stiffness the patient faces.
MEDICAL HISTORY
Patients notice the signs and symptoms of injury including pain, swelling, stiffness, and deformity.
EXAMINATION
Any deformity must be carefully noted. The amount of motion that is possible is important for planning. Function of the associated tendons and nerves are checked.
ADDITIONAL TESTS
Plain x-rays are all that is needed.
TREATMENT OPTIONS
| NON-OPERATIVE | SURGICAL PINNING | SURGICAL FIXATION | |
| CONSISTS OF | Splinting | Temporary smooth sided wires hold the bones in the correct position | Screws or plates on the inside |
| FEATURES | Fracture must be naturally stable | Wires out by 4 weeks later, outpatient surgery | Formal incision, outpatient surgery |
| ADVANTAGES | Avoids surgery | Sets and keeps the correct position, no incisions | Most correct position, solid fixation |
| DISADVANTAGES | Position of fracture may slip while splinted | Anesthetic, risk of pin tract infection, can’t control finger rotation well | Most invasive, most stiffness |
RECOVERY
Early motion is the key to preventing stiffness no matter which of the 3 plans is chosen. Outpatient therapists will offer a protective splint in between hourly sessions to move the affected joints. The more committed the patient is to his own rehabilitation, the better the final outcome. If pins are used, the therapy may not begin until they are removed. If internal fixation with screws or plates is used, therapy must begin right away. Bone healing is usually complete by around 8 weeks post-op. Unrestricted use is usually allowed by 3 months post-op.
