Finger fractures and hand fractures are the most common fractures of the upper extremity globally as well as in our Caribbean hand surgery clinic at Trinidad Institute of Plastic Surgery. In a series of 11,000 fractures 10% involved the fingers and metacarpal bones. About 70% of all hand fractures ( finger fractures and fractures of the metacarpals) occur between 11 and 45 years of age.
In the early parts of the 20th Century, hand fractures were treated conservatively with splinting with or without manipulation. The operative treatment of hand fractures ( finger and metacarpal bones) is limited to the last 80 years. Even today, a significant number of hand fractures can be treated successfully with conservative techniques. Many of hand fractures are functionally stable before or after manipulation and heal with immobilization in a splint. Other patterns of finger fractures, metacarpal fractures and hand fractures require surgical fixation (osteosynthesis). The choice between conservative or surgical treatment depends on many factors. Important are localization (intra-articular or extra-articular finger fractures), geometry of the fracture (transverse, spiral or oblique fractures, comminuted fractures), deformity (angulation, rotation, shortening), whether the fracture is open or closed, the presence of soft tissue injuries and the intrinsic fracture stability ( redislocation after manipulation). Other considerations include the patient’s age, occupation, presence of systemic diseases and expected cooperation of the patient.
In the last three decades, the surgical treatment of fractures of finger fractures, metacarpal fractures and hand fractures has increasingly gained popularity. Some reasons for this are advances in implant design (titanium or steel plates and screws) and instrumentation, a better understanding of the biomechanical principles of fracture fixation, improved imaging technologies (CT, intraoperative x-ray machines), expectations of the public, availability of specialists in hand surgery, optimized anesthesia procedures and effective protocols in physiotherapy treatment.
A pillar of the philosophy of fracture treatment is the recognition that bone healing is a race between bone strength and hand stiffness.
Prolonged immobilization during nonoperative treatment poses a risk of stiffness as well as overly aggressive attempts of osteosynthesis due to soft tissue damage during exposure of the fracture, infections, and the possibility of a second operation to remove the implant. Operative fixation should be used with the expectation that the end result is at least as good as and ideally better than the outcome after conservative treatment.
Contact us to get on the road to recovery.
Visit the Hand Surgery Forum !
Trinidad Institute of Plastic Surgery – the superior choice for hand fractures treatment in the Caribbean, Antigua and Barbuda, The Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Jamaica, Montserrat, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago, Bermuda, British Virgin Islands, Cayman Islands, Turks and Caicos Islands, Miami, New York, Toronto, London