Comprehensive Care for Upper Extremity Fractures
Rochester Regional Health’s Orthopedics Upper Extremity Program provides diagnosis and treatment for all manner of elbow, hand, wrist, and upper extremity fractures. We treat many conditions, from common injuries to complex bone and joint disorders, using the latest in surgical and non-operative techniques. And, as part of a large health system, we can seamlessly connect you with experienced specialists and colleagues to ensure you receive the best possible care and rehabilitation.
Common Upper Extremity Fractures
Your hand contains 27 bones, including the eight in your wrist, the fourteen in your fingers, and the five in the palm of your hand. There are a lot of bones in this small section that can fracture, typically the result of an injury to your hand.
Your wrist is comprised of eight small bones, plus the two long bones in your forearm, the radius, and the ulna. The most common wrist injury is to your scaphoid bone, which is found at the base of your thumb.
Finger Fractures
Because the bones in our hands line up very precisely, a finger injury can set the whole hand out of alignment, making using your hand painful and difficult. Finger fractures are commonly caused by an injury to your hand, like breaking a fall, slamming fingers, or accidents when working with power tools.
The symptoms of a finger fracture include:
- Bruising
- Deformed appearance
- Difficulty moving the injured finger
- Swelling
- Tenderness
If you suspect a finger fracture, have it examined by a healthcare professional immediately. The physician will determine whether your finger is fractured, and what kind of break you have–straight across the bone, a spiral, several pieces, or a completely shattered bone. Once your finger has been assessed, your physician will determine what type of treatment will work best for you.
If your provider determines that a non-surgical treatment will be best for your finger following a thorough examination and X-ray, then they will put your broken bone back into place. A cast or splint will keep your finger straight and protect it from any further injury as it heals. Every fracture varies, but a splint is typically worn for three weeks. During this time, your physician may monitor your healing progress with X-rays.
The severity or type of your fracture will determine if surgery is the best treatment for you. Surgical options include implanting metal pins, screws, or wires to hold the fractured bone firmly in place until it has healed.
Hand Fractures
Often the result of a fall, a twisting injury, a crush injury, or direct contact in sports/activities, a fracture of the hand can occur in either the small bones of your fingers (phalanges) or your long bones (metacarpals).
The symptoms of a hand fracture include:
- An appearance of deformity
- Depressed knuckle
- Finger crossing over a neighbor when you make a fist
- Inability to move a finger
- Pain
- Swelling
- Tenderness
If you are suffering from the symptoms above or believe your hand may be fractured, please see your physician immediately. Your injury will be assessed via range-of-motion tests, checking the position of your fingers and the condition of your skin, and evaluating the feeling in your fingers to test for nerve damage. An X-ray may also be used to assess the location and extent of the fracture.
Typically, a hand fracture can be realigned without surgery, instead of using manipulation. A cast, fracture brace, or splint will be applied to immobilize your hand bones after your manipulation. While all fractures are different, a cast is usually worn for three to six weeks and will extend from the fingertips past your wrist.
Open or compound fractures (those that break through the skin) typically need surgery to align and restabilize your bones. Your orthopedic surgeon will insert plates, screws, or wires into the broken bone to hold the fractured bone more firmly in place. As you heal, your surgeon may examine your hand to ensure your joints are not contracting or tightening. After your bone has healed, the implants can be removed or left in place–depending upon your needs and your injury.
Distal Radius Wrist Fractures
Your radius is the larger of the two bones in your forearm. When the area of your radius near your wrist (called the distal end) breaks, we call it a distal radius fracture. Broken wrists occur in healthy bones if the force of the trauma on the distal radius is severe enough. They’re commonly found in people who have landed on an outstretched arm when trying to break a fall. Biking, car, and skiing accidents also commonly cause this type of broken wrist.
Symptoms of a broken wrist include:
- Acute/immediate pain
- Bruising
- Swelling
- Tenderness
Your wrist may also hang at an odd angle or appear slightly deformed if you have a distal radius wrist fracture. If your wrist is extremely painful, appears deformed, feels numb, or if your fingers are not pink/not their normal color, please go to the emergency room immediately.
After an X-ray, your physician will be able to diagnose your fracture and determine its type and severity. If nonsurgical treatment will work for your fracture, your physician will realign or reduce your broken wrist to help it heal correctly. Once your bone has been properly aligned, your doctor may place a splint on your arm to allow for normal swelling. After the swelling has gone down, a cast can be added to protect your wrist and allow it to heal.
If your fractured bone cannot be realigned without an incision, if the fractured bone is out of place, or if a cast cannot sufficiently hold the bone in place, surgery may be the best treatment option. Using metal pins, a plate and screws, and/or an external fixator, your orthopedic surgeon can perform an open reduction to provide an accurate realignment.
Healing and recovery for both non-surgical and surgical treatments depend on your injury and lifestyle, but you can typically expect pain for a few days or up to several weeks. Over-the-counter pain medication and elevating the injured arm above your heart should help you find relief from pain.
Scaphoid Wrist Fracture
Found at the base of your thumb in the area where your wrist bends, the scaphoid is one of the small bones in your wrist. The scaphoid is the most likely bone in your wrist to break, and fractures occur in people of all ages. Car accidents, sports injuries, and breaking a fall are the most common reasons for scaphoid fractures.
Symptoms of a scaphoid fracture include:
- Pain and swelling at the base of your thumb
- Severe pain when you move your thumb or wrist
If the pain in your wrist does not subside within a day of the injury, you may have a fracture, not a sprain. If your symptoms persist, please seek immediate medical care.
Your physician will use an X-ray to determine if your scaphoid is fractured. In some cases, the fracture may not show on the X-ray, and your provider will splint your wrist and have you return later when the fracture will be more evident.
The best treatment for your wrist depends on the location of your fracture.
- Near the thumb: there’s a good supply of blood which aids in healing, and it can mend in a few weeks with proper protection
- In the middle of the bone: healing is more difficult because there’s less blood
- Closer to your forearm: healing is more difficult because there’s a less efficient blood supply
Non-surgical treatment options will use a cast that will remain on your hand and wrist throughout the healing process. Your physician will determine how far the cast extends down your arm, depending on where your scaphoid fractured.
If your scaphoid is fractured at the middle of the bone or closer to your forearm, surgery may be suggested. Your orthopedic surgeon will implant screws and/or wires to hold your bone firmly in place until it is completely healed.