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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.

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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.

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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.

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Complications

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.

[11]

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Prognosis

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

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Patient Education

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

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Contributor Information and Disclosures
Author

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.

Acknowledgements

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.

References
  1. Hammert WC. Treatment of nonunion and malunion following hand fractures. Clin Plast Surg. 2011 Oct. 38 (4):683-95. [Medline].

  2. [Guideline] Rubin DA, Daffner RH, Weissman BN, Bennett DL, Blebea JS, Jacobson JA, et al. ACR Appropriateness Criteria acute hand and wrist trauma. [online publication]. Reston (VA): American College of Radiology (ACR). 2008. [Full Text].

  3. Oetgen ME, Dodds SD. Non-operative treatment of common finger injuries. Curr Rev Musculoskelet Med. 2008 Jun. 1(2):97-102. [Medline]. [Full Text].

  4. Capo JT, Hall M, Nourbakhsh A, Tan V, Henry P. Initial management of open hand fractures in an emergency department. Am J Orthop (Belle Mead NJ). 2011 Dec. 40 (12):E243-8. [Medline].

  5. Henry MH. Fractures of the proximal phalanx and metacarpals in the hand: preferred methods of stabilization. J Am Acad Orthop Surg. 2008 Oct. 16(10):586-95. [Medline].

  6. Ozçelik D, Toplu G, Unveren T, Kaçagan F, Senyuva CG. Long-term objective results of proximal phalanx fracture treatment. Ulus Travma Acil Cerrahi Derg. 2011 May. 17(3):253-60. [Medline].

  7. Ben-Amotz O, Sammer DM. Practical Management of Metacarpal Fractures. Plast Reconstr Surg. 2015 Sep. 136 (3):370e-9e. [Medline].

  8. Kollitz KM, Hammert WC, Vedder NB, Huang JI. Metacarpal fractures: treatment and complications. Hand (N Y). 2014 Mar. 9 (1):16-23. [Medline].

  9. Pavic R, Malovic M. Operative treatment of Bennett's fracture. Coll Antropol. 2013 Mar. 37(1):169-74. [Medline].

  10. Houshian S, Jing SS. Treatment of Rolando fracture by capsuloligamentotaxis using mini external fixator: a report of 16 cases. Hand Surg. 2013. 18(1):73-8. [Medline].

  11. Gajendran VK, Gajendran VK, Malone KJ. Management of complications with hand fractures. Hand Clin. 2015 May. 31 (2):165-77. [Medline].

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

  13. Antosia R, Lyn E. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998.

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

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

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

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

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

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

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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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