HAND FRACTURE, CARPAL |
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General Information
DEFINITION--A complete or incomplete break in any one of several bones of the hand.
BODY PARTS INVOLVED
Any carpal bone in the hand.
Wrist joint.
Any of the joints between the hand and fingers.
Soft tissue surrounding the fracture site, including nerves, tendons, ligaments and blood vessels.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Swelling of soft tissue surrounding the fracture.
Tenderness to the touch.
Numbness and coldness beyond the fracture site if the blood supply is impaired.
CAUSESDirect blow or indirect stress to the bone. Indirect stress may be caused by twisting or violent muscle contraction.
RISK INCREASES WITH
Contact sports, especially boxing.
History of bone or joint disease, especially osteoporosis.
Poor nutrition, especially calcium deficiency.
HOW TO PREVENT
Use appropriate protective equipment, such as boxing gloves for boxing.
If you have had a previous hand injury, protect the hand with taping and padding when participating in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to immobilize the broken bones.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of injured areas, including joints above and below the primary injury site.
Repeat X-rays are frequently needed about 2 weeks after injury, if the original X-rays were negative and pain continues.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Misdiagnosis as a wrist sprain, delaying proper treatment.
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels, or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site).
Shortening of the injured bones.
Proneness to repeated hand injury.
Unstable or arthritic joint following repeated injury.
Prolonged healing time if activity is resumed too soon.
Problems caused by casts. See Appendix 2 (Care of Casts).
PROBABLE OUTCOMEIt is impossible to predict exactly how long it will take for any fracture to heal. Variable factors include age, sex, and previous state of health and conditioning. The average healing time for this fracture is 4 months. Healing is considered complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Use a padded splint or sling to immobilize the hand and wrist before transporting the injured person to the doctor's office or emergency facility.
Keep the person warm with blankets to decrease the possibility of shock.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Immobilization will be necessary. Rigid casts or splints are placed around the hand to immobilize the joint above and the joint below the fracture site. After the cast has been removed, the hand needs protection with taping or with a leather gauntlet.
After 48 hours, localized heat promotes healing by increasing blood circulation in the injured area. Use a heating pad or heat lamp so heat can penetrate the cast.
After the cast is removed, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a baseball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
Apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
Narcotic or synthetic narcotic pain relievers for severe pain.
Acetaminophen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Actively exercise all muscle groups not immobilized. These muscle contractions promote fracture alignment and hasten healing.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
Begin reconditioning the injured area after clearance from your doctor.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin daily rehabilitation exercises when movement is comfortable. Use ice massage for 10 minutes prior to exercise. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a hand fracture.
Any of the following occur after treatment:
Increased pain or swelling in the injured area.
Swelling above or below the cast or splint.
Change in skin color to blue or gray beyond the cast, particularly under the fingernails.
Numbness or complete loss of feeling in the hand, fingers or thumb.
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