Hand | Fractures (bone fractures)

Fractures (bone fractures)

Our hand usually consists of 27 bones. Both hands together make up a quarter of the human skeleton. With this number and delicacy, injuries can easily occur in accidents. Surgery is not always necessary, but there are clear indications. Sometimes bone healing is delayed or absent, resulting in complex treatment. A correspondingly clear processing is indispensable, modern apparatus examinations help to make the diagnosis.

Which bones can break?

Any human bone can break. The hand consists of eight carpal bones and 19 long tubular bones, which are most likely to break due to their anatomical fineness. Complex fractures can occur depending on the force exerted and the patient’s previous illness. The most common fracture in humans is wrist fracture, which is misleading because the radius is broken. Complex situations with combined injuries of ligament structures (TFCC) can also occur here. Scaphoid fractures (scaphoid bone) or triquetrum fractures are most common in carpal bones. With the long tubular bones, the metacarpal bones occur most frequently, especially on the thumb.

When is surgery necessary?

This depends on the affected bone malposition and any signs of instability. In the case of dislocated (displaced) fractures, an operative procedure is usually indicated. In the case of non-union fractures, malunion fractures or pseudarthrosis, an operative procedure is unavoidable. Non-dislocated scaphoid bone or radius fractures can usually be treated conservatively by immobilization. Sometimes, however, an operation is relatively indicated in these cases, i.e. a faster or safer healing can be achieved with the operation. The same applies to metacarpal fractures.

Am I the right candidate for surgery?

This depends on the affected bone and position of the fragments, the personal pre-existing conditions and the personal requirements. If the bone parts are displaced and there are no serious previous illnesses, an operation is usually indicated. An operation has the advantage that an early functional after-treatment enables a better and faster mobilization. This is particularly advantageous for older patients and certain joints. Each fracture must be assessed individually and worked out together according to the treatment plan.

What can I expect?

The bone is a well supplied with blood anatomical structure, which allows a fast healing in principle. As a rule, good to very good results can be expected here. Should non healing nevertheless occur, they must be corrected. Certain bones such as the scaphoid tend to take relatively long to heal and have higher complication rates than long tubular bones. In the case of fractures which are close to the joint or if the joint itself is affected, anatomically correct reduction is extremely important. Good results can be expected with correctly performed operations.

What happens during consultation hours?

During the initial consultation we will try to make a diagnosis. Imaging such as X-rays or computer tomographies are central, since the bones are displayed here. Other imaging techniques such as MRI are particularly indicated for pseudarthrosis. In any case, a detailed explanation of the planned intervention or conservative therapy is given.

What's the surgery like?

Operations on finger and metacarpal bones are usually performed using regional anaesthetic procedures and on an outpatient basis. Radius fractures or large reconstructions requiring bone transplantation are operated in general anaesthesia under inpatient conditions. The procedure is usually an open reduction and fixation with plates or screws. In rare cases, only so-called K-wires can hold the bone pieces in position if the bone is too fine or too complex.

What about the follow-up treatment?

Since every intervention, no matter how small, involves a certain risk of complications, certain measures should be observed. The first few days you will feel normal, timely pain, which can be relieved with painkillers. For larger operations, in-patient stays are possible. Regular wound checks are carried out to ensure safe wound healing. Depending on the affected bone and postoperative result, immobilization may also be necessary. As a rule, a hand therapeutic accompaniment to mobilisation is indicated. The aim of all post-operative treatments is to achieve the earliest possible movements with a high degree of safety and freedom from pain. The follow-up treatment is already discussed in the initial consultation so that you can plan the postoperative phase already and any help for everyday life and inability to work can be organized.

What are the risks?

Every intervention, however small, involves a certain risk of complications, since an operation in the broadest sense always leads to tissue injuries. A complication does not necessarily occur due to an error. Rather, the human body reacts individually and has certain tendencies to complications. The initial clarifying discussion serves to address such tendencies and to take appropriate precautions.

General risks of an operation are

  • secondary bleedings
  • wound healing disorders
  • infections
  • Excessive scars
  • thromboses
  • embolisms

Specific risks associated with fractures depend on the diagnosis and localization of the operation. A general risk is the malunion or non-union of the fracture. It should also be noted that bone surgery can lead to increased pain. We will be happy to provide you with specific advice as part of the surgical clarification.

Would you like to learn more?

Usually the diagnosis of a bone fracture is suspected or made in the context of the initial emergency presentation. In very rare cases, the fracture must be treated immediately. Thus the operation can be planned calmly. We will be happy to advise you within the framework of an initial consultation on referral by your family doctor or directly with us. Please note whether you are in an HMO or other general practitioner model and inform your general practitioner.  During the initial consultation, we will work out the diagnosis together and, if necessary, take the first therapeutic steps. An operation will always take place later.

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