What Are Hand Fractures?
There are many classifications of bone fractures. Treatment can range from simple splinting to casting to operations with metal pins or plates, depending on the type of fracture your child has.
Types of Fractures
Open vs. Closed Fractures
Fractures that happen without tearing the skin are called closed. If there is an opening in the skin, the fracture is called open. Open fractures are more likely to develop infection. Open fractures must be cleaned thoroughly, and your child must take antibiotic medication.
Shaft, Growth Plate and Joint Fractures
If fractures are in the middle of the bone and do not involve a joint, they are called shaft fractures. In children, unlike adults, there are growth centers in the flared end of the bones. Fractures in these growth areas are called Salter Harris fractures and can make children's fractures more difficult to treat than a similar fracture in an adult.
A small percentage of growth plate fractures develop a growth arrest, which can lead to a short or crooked bone. Growth plate fractures may need to be followed for six to 12 months after healing to ensure proper growth.
If the fracture crosses into the joint, the fracture is intra-articular. Intra-articular fractures, if small, can be treated with temporary splinting and then gentle motion exercises. Larger fractures may require fixation in the operating room. Whenever the joint is involved, there is a possible loss of motion in the joint. There is also the possibility of arthritis. The best results happen when all therapy exercises are done properly and regularly.
Simple vs. Comminuted Fractures
When a clean fracture line can be found with two bone fragments, the fracture is described as a simple fracture. If there are multiple lines of fracture with more than three pieces of bone, the fracture is called comminuted.
Comminuted fractures are more difficult to reduce (put back into place) than simple fractures. Occasionally, even simple fractures in bad spots can be difficult to reduce.
Stable vs. Unstable Fractures
Stable fractures stay put after they have been reduced. In this case, a cast or splint will continue to hold the fracture until it has time to heal. Unstable fractures keep returning to their fractured position after reduction and need some type of hardware (pins, plates, wires or screws) to keep them in place.
Splints / Casts
Casts and thermoplastic splints are the most common form of treatment to protect finger fractures during healing. Some athletes can continue with contact sports if properly protected during healing.
After Treatment
Before Your Child’s Orthopaedic Appointment
Leave the splint placed on the arm intact. It must stay clean and dry. The bandage will be removed in the office about five to 10 days later. If a cast is needed, it will be placed during the clinic visit.
Keep the hand elevated higher than the heart. Have your child use a sling when they are walking around. Prop your child's arms on pillows when they are sitting or lying down. This simple step will decrease both swelling and throbbing pain. Ice packs are also helpful.
Managing Pain
The pain usually decreases quickly after the first 48 hours. During the first two days, pain medications like acetaminophen (Tylenol®) or ibuprofen (Motrin®) may be needed. The doctor or nurse will give you medication instructions for your child. If pain does not improve after an hour of elevation, ice and pain medicine, contact your child's doctor.
If Your Child is Wearing a Splint or a Cast
It is important to check for signs of swelling every three to four hours. Check to see that the fingertips are pink and able to wiggle. If there is a change in the motion or color of the fingers, contact the orthopaedic nurse or doctor.
Tips
Pins generally remain in place for six weeks. Casting may remain in place for two to six weeks. Casts must be checked weekly at home for fit and cleanliness. Occupational therapy may be needed after treatment of the fracture. It is important that your child does all their therapy activities.
