eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Hand: Follow-up

Author: Jon Alke, MD, Staff Physician, Stanford/Kaiser Emergency Medicine Residency, Stanford University School of Medicine
Coauthor(s): Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Contributor Information and Disclosures

Updated: Jul 29, 2008

Follow-up

Further Inpatient Care

  • Care for the vast majority of patients with hand fractures as outpatients.
  • Reserve inpatient care for those who must go directly to the operating room for ORIF. This is not a common occurrence.

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.

Transfer

  • 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

  • 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

Prognosis

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

Patient Education

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, William R Fraser, DO, to the development and writing of this article.



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Multimedia: Fracture, Hand
References
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References

  1. American Society for Surgery of the Hand, Idler RS, Mantktelow RT. The Hand Examination and Diagnosis. New York: Churchill Livingstone; 1990:13-73.

  2. Emergency Medicine: Concepts and Clinical Practice [book on CD-ROM]. Mosby-Year Book; 1998. Antosia R, Lyn E.

  3. Harwood-Nuss A, Wolfson A. Hand injuries. In: Clinical Practice of Emergency Medicine. 4th ed. 2005:1062-1065.

  4. Rosen P, Doris P. Musculoskeletal trauma. In: Diagnostic Radiology in Emergency Medicine. 1992:178-182.

  5. Ruiz E, Cicero JJ. Hand injuries and infections. In: Emergency Management of Skeletal Injuries. St. Louis, MO: Mosby-Year Book; 1990:339-59.

  6. Stewart C, Winograd S. Hand injuries: a step by step approach for clinical evaluation and definitive management. Emerg Med Rep. 1997;18:223-234.

  7. Tintinalli JE, Ruiz E, Krome RL. Injuries to the hand and digits. In: Emergency Medicine: A Comprehensive Study Guide. 2004. 6th ed. New York: McGraw Hill; 2004:1665-1674.

  8. Simon RR, Koenigsknecht SJ. Fractures of the hand. In: Emergency Orthopedics. 4th ed. New York: McGraw-Hill; 2001:97-133.

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Further Reading

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Keywords

hand fracture, broken hand, hand injury, fractures of the phalanges, volar fracture dislocation, middle phalanx fractures, transverse fracture of distal phalanx, middle phalangeal fractures, proximal phalangeal fractures, transverse fracture of the proximal phalanx, oblique fractures, spiral fractures, condylar fractures, metacarpal fractures, metacarpal head fractures, metacarpal neck fractures, metacarpal shaft fractures, metacarpal base fractures, Bennett fractures, Rolando fractures

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital, Manhattan
Eric Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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