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Hand Fracture Follow-up

  • Author: Erik D Schraga, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
Updated: Oct 17, 2015

Further Outpatient Care

Because most patients have splints applied in the ED, discharge instructions should include signs and symptoms of constrictive splints or casts. Instruct patients of date and time of their follow-up appointment with an orthopedic surgeon or the phone number to call for an appointment.

Instruct patients to rest and elevate the injured hand to reduce swelling and pain. Cold packs may also be recommended to minimize swelling.


Further Inpatient Care

Care for the vast majority of patients with hand fractures is completed on an outpatient basis.

Reserve inpatient care for those who must go directly to the operating room for open reduction and internal fixation (ORIF). This is not a common occurrence.



Transfer of the patient with a hand fracture seldom is required.

An exception is the patient with an amputated digit or hand requiring transfer to a hospital capable of emergent reimplantation.



Complications include the following:

  • Malrotation
  • Degenerative arthritis
  • Adhesion of tendon to bone (more likely in open or widely angulated fractures)
  • Joint stiffness from immobilization
  • Boutonniere deformity (may result from improperly treated middle phalanx fracture)
  • Nonunion of fractures resulting in prolonged disability

Both operative and nonoperative treatment of hand fractures can result in numerous complications, including stiffness, malunion, nonunion, arthritis, infection, and complex regional pain syndrome.




The prognosis is excellent with good ED management and appropriate, timely referral.


Patient Education

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education article, Broken Hand.

Contributor Information and Disclosures

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Francis Counselman, MD, FACEP Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, Association of Academic Chairs of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.


Jon Alke, MD Staff Physician, Stanford/Kaiser Emergency Medicine Residency, Stanford University School of Medicine

Jon Alke, MD is a member of the following medical societies: American College of Emergency Physicians and Emergency Medicine Residents Association

Disclosure: Nothing to disclose.

William R Fraser, DO Associate Clinical Professor, Department of Emergency Medicine, Ohio University College of Osteopathic Medicine; Program Director, Department of Emergency Medicine, Doctors Hospital

William R Fraser is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

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Assessment of the hand for rotational deformities of the fingers or metacarpals is essential, as such deformities, if untreated, may result in significant functional compromise. With fingers flexed at the metacarpophalangeal and proximal interphalangeal joints and extended at the distal interphalangeal joints, fingers should all point toward the scaphoid bone (see image).
Phalangeal fractures. Complex unstable fracture of the proximal phalanx. Image courtesy of Mark Baratz, MD.
Displaced fourth and fifth metacarpal fractures, anteroposterior view.
Fourth and fifth metacarpal fractures, oblique view.
Metacarpophalangeal ligaments.
Metacarpophalangeal musculoskeletal structure.
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