Hand and wrist fractures

Fractures of the hand and wrist are among the most common musculoskeletal injuries. They may result from falls, sporting trauma or workplace accidents. Appropriate treatment is essential to restore anatomy and prevent long-term functional problems.

Most common fracture types

• Distal radius fracture: the most common wrist fracture, typically caused by a fall onto an outstretched hand
• Scaphoid fracture: common in young adults and athletes, with a risk of avascular necrosis if left untreated
• Metacarpal fractures: frequently caused by direct impact (including the boxer's fracture)
• Phalangeal fractures: resulting from crush injuries, blows or domestic accidents

Symptoms

• Immediate and severe pain following the injury
• Swelling and bruising in the affected area
• Visible deformity in displaced fractures
• Inability or difficulty moving the fingers or wrist

When to seek urgent assessment

Urgent assessment is needed when there is visible deformity, an open wound, loss of sensation, cold or pale fingers, or severe pain despite immobilisation. Remove rings, elevate the hand and do not attempt to straighten a deformity before medical assessment.

Diagnosis

Plain radiographs confirm the majority of fractures. In complex cases or suspected scaphoid fractures, a CT scan or MRI may be required to assess displacement and plan the most appropriate treatment.

Non-surgical treatment

Stable, non-displaced fractures can be managed with immobilisation (plaster cast or splint) for four to six weeks. Regular radiographic checks are carried out to ensure proper bone healing.

Surgical treatment

Displaced, unstable or intra-articular fractures require surgery to restore normal anatomy. Plates, screws, wires or external fixators may be used depending on the fracture pattern. Surgical fixation allows earlier mobilisation and improved functional outcomes.

Recovery

Recovery time varies according to the type of fracture: from four weeks for simple phalangeal fractures to up to three months for complex wrist fractures. Rehabilitation is essential to regain full range of motion and strength.