Management of Hand Fractures: Simple to Complex

Hand fractures are among the most common skeletal injuries. Approximately 150,000 hand fractures occur in the United States each year. The management of hand fractures consists of reduction, immobilization, and rehabilitation to return patients to their preinjury status. Hand fractures are managed by restoring articular congruity, reducing malrotation and angulation of the fracture, and maintaining the reduction, all of which should be accomplished with minimal surgical intervention. Surgeons must assess concomitant soft-tissue injuries and respect the soft tissues during the surgical management of hand fractures. Fractures through the metaphyseal bone at the base and neck will heal more quickly than fractures through the diaphyseal bone of the shaft, which makes provisional fixation of metaphyseal fractures more practical compared with provisional fixation of diaphyseal fractures. The fracture pattern determines the most practical type of fixation. Patterns of angulation should be anticipated and corrected during reduction. More rigid fixation is required if substantial comminution and bone loss are present. Bone loss also indicates a high-energy injury, which likely indicates more substantial soft-tissue injury. As the number of injured structures increases, the likelihood of full function after rehabilitation decreases.