Conditions & Treatments

Fractures

Facts about Elbow, Hand, and

Wrist Fractures

Arora Hand Surgery in St. Clair Shores, Howell, Macomb Township, and West Bloomfield treats elbow, hand, and wrist fractures with expertise and compassion. Arm fractures are painful and will take time to heal, but recovery is possible with the best local hand surgeon by your side.

Elbow

Fractures

The elbow is a hinge joint comprised of 3 bones: humerus, radius and ulna. Ligaments hold the bones together to provide stability to the joint.

Muscles and tendons originate and insert onto the bones around the elbow to provide force to move the bones and perform activities.

Elbow fractures may result from falling onto an outstretched arm, a direct impact to the elbow, or a twisting injury. Sprains, strains, or dislocations may occur at the same time as a fracture.

Elbow Fracture Signs and Symptoms

Pain, swelling, bruising, and stiffness in and around the elbow suggest a possible fracture. A snap or pop at the time of injury may be felt or heard. Skin openings may reflect communication between the bone and the outside environment.

Visible deformity would indicate displacement of the bones or a dislocation of the elbow joint. It is always important to check for possible nerve and/or artery damage.

Diagnosis & Treatment

X-rays are used to confirm the presence of an elbow fracture and to determine if the bones are displaced.

A CT scan might be necessary to obtain further detail, especially of the joint surface.

Stiffness is a major concern after any fracture. Elbow fracture treatment is therefore focused on maximizing early motion. Conservative treatment (sling, cast) is usually used when the bones are at low risk of moving out of place, or when the position of the bones is acceptable.

Age is also an important factor when treating elbow fractures. Casts are used frequently in children, as their risk of developing stiffness is small; however, in an adult, elbow stiffness is much more likely.

Fractures that are displaced or unstable are more likely to need surgery to realign and stabilize the fragments, or sometimes to remove bone fragments, and ideally allow for early motion. Whenever a fracture is open (skin broken over the fracture), urgent surgery is needed to clean out the tract and bone so as to minimize the risk of a deep infection.

Therapy is often utilized to maximize motion. This might include exercises, scar massage, modalities such as ultrasound, heat, ice, etc., and splints that stretch the joint (static progressive or dynamic splints).

Types of Elbow Fractures

Radial head and neck fractures
Pain is usually worse with forearm rotation. It is critical to detect the presence of a mechanical blockage of motion from displaced fracture fragments. The specific type of treatment depends on the number and size of the fragments. Nondisplaced fractures are treated with early motion. Complex fractures often require surgery to repair and stabilize the fragments; to remove the radial head if the fragmentation is too severe; or to replace the radial head.

Olecranon fractures
Stable fractures can be initially treated with splint immobilization, followed by gradual motion exercises. Severely displaced or unstable fractures require surgery. The bone fragments are re-aligned and held together with pins and wires or plates and screws.

Fractures of the distal humerus
These fractures occur commonly in children and in the elderly.

Nerve and/or artery injuries can be associated with these types of fractures and must be carefully checked for. These fractures usually need surgery, except for those that are minimally or non-displaced, stable, and have no associated nerve or artery injury.

Wrist

Fractures

The wrist is made up of eight small bones and the two forearm bones, the radius and ulna. The shape of the bones allows the wrist to bend and straighten, move side-to-side, and rotate, as in twisting the palm up or down.

A fracture may occur in any of these bones when enough force is applied, such as when falling down onto an outstretched hand. Severe injuries may occur from a more forceful injury, such as a car accident or a fall off a roof or ladder.

Osteoporosis, a common condition in which the bone becomes more brittle, may make one more susceptible to getting a wrist fracture.

The most commonly broken bone of the wrist is the radius. Many people think that a fracture is different from a break, but they are the same. When the wrist is broken, there is pain, swelling, and decreased use of the hand and wrist.

Often the wrist appears crooked and deformed. Fractures of the small wrist bones, such as the scaphoid, are unlikely to appear deformed.

Fractures may be simple with the bone pieces aligned and stable. Other fractures are unstable and the bone fragments tend to displace or shift, in which case the wrist is more likely to appear crooked.

Some fractures break the normally smooth, ball bearing-like joint surface; others will be near the joint but leave the joint surface intact. Sometimes the bone is shattered into many pieces, which usually makes it unstable.

An open (compound) fracture occurs when a bone fragment breaks through the skin. There is some risk of infection with compound fractures.

Examination & Treatment

Examination and X-rays are needed so that the doctor can tell if there is a fracture and to help determine the treatment. Sometimes a CT scan or MRI may be used to get better detail of the fracture fragments and associated injuries.

In addition to the bone, ligaments (the structures that hold the bones together), tendons, muscles, and nerves may be injured as well when the wrist is broken. These injuries may need to be treated along with the fracture.

The pattern of the fracture – whether it is displaced or non-displaced and whether it is stable or unstable – are all factors in determining the treatment. Other important considerations include your age, overall health, hand dominance, work and leisure activities, the presence of any prior injury or arthritis, and any associated injuries.

A splint or cast may be used to treat a fracture that is not displaced or to protect a fracture that has been set. Other fractures may need surgery to properly set the bone and/or to stabilize it.

Fractures may be stabilized with pins, screws, plates, rods, or external fixation. External fixation is a method in which a frame outside the body is attached to pins which have been placed in the bone above and below the fracture site, in effect keeping it in traction until the bone heals.

Sometimes arthroscopy is used in the evaluation and treatment of wrist fractures. The hand surgeon will determine which treatment is the most appropriate in your individual case.

On occasion, bone may be missing or may be so severely crushed that there is a gap in the bone once it has been re-aligned. In such cases, a bone graft may be necessary. In this procedure, bone is taken from another part of the body to help fill in the defect. Bone from a bone bank or synthetic bone graft substitutes may also be used.

While the wrist fracture is healing, it is very important to keep the fingers flexible, provided that there are no other injuries that would require that the fingers be immobilized. Otherwise, the fingers will become stiff, hindering the recovery of hand function. Once the wrist has enough stability, motion exercises may be started for the wrist itself. Your hand surgeon will determine the appropriate timing for these exercises. Hand therapy is often used to help recover flexibility, strength, and function.

Recovery & Prognosis

Recovery time varies considerably, depending on the severity of the injury, associated injuries, and other factors as noted previously. It is not unusual for maximal recovery from a wrist fracture to take several months. Some patients may have residual stiffness or aching. If the surface of the joint was badly injured, arthritis may develop. On occasion, additional treatment or reconstructive surgery may be needed.

Hand

Fractures

Hand fractures can be the result of a variety of accidents and impact numerous parts of the hand, from the smaller bones in the fingers to the longer ones. A hand fracture can be caused by a fall, direct contact in physical activity, and a twisting or crushing injury, along with many other possibilities.

Two of the most common types of hand fractures are phalanges fractures and metacarpal fractures.

Phalanges fractures occur in the fourteen smaller bones of the fingers. The thumb contains two phalanges, while the other fingers contain three each.

Metacarpal fractures are a break in one or more of the five long metacarpal bones of the fingers.

Signs of a Hand Fracture

Because they are often associated with an injury and can be painful, hand fractures typically require urgent or emergency care. Signs of a hand fracture include:

  • Deformity
  • Swelling
  • Inability to move
  • Tenderness
  • Shortened finger
  • One finger crossing over another when trying to form a fist
Examination & Treatment

Dr. Arora can examine and assess the fingers as well as the condition of the skin to better determine if you are experiencing a hand fracture.

Dr. Arora may test the motion and sensitivity in the fingers. A check of finger motion allows Dr. Arora to determine if there is any significant loss of finger length or loss of the normal alignment of the fingers. Testing the sensitivity to touch in the finger helps determine whether there is nerve damage within the hand. An X-ray is also taken to closely assess the extent and location of the fracture.

The location and extent of the fracture will determine the course of treatment.

One common method for treating a hand fracture is by wearing a splint or brace. Splints are used to cover and protect part of the fingers in addition to both sides of the hand and wrist. How long you may need to wear the splint will also depend upon the extent of the fracture.

Another possible treatment option is surgery, based on accepted standards and the nature of your fracture. Dr. Arora will help determine what is right for your fracture and take into consideration your individual situation and needs.

You may require surgery if:

  • Your metacarpal bones are broken and misaligned
  • Your fingers do not align correctly
  • The fracture has broken through the skin
  • The pain gradually worsens
Recovery & Future Appointments

Dr. Arora will provide you with aftercare instructions that we strongly recommend following to promote optimal healing. Should a splint be necessary, we advise you not to remove it until instructed to do so.

Medication may be prescribed to you to help alleviate sensations of pain and discomfort. Patients should keep their affected hand elevated as much as possible to help reduce swelling and discomfort. All patients who undergo hand fracture treatment will make follow-up appointments so that Dr. Arora can monitor your recovery.

If you are experiencing any signs or symptoms of an elbow, wrist, or hand fracture, contact us to schedule an appointment with our hand surgeon in West Bloomfield, Howell, Macomb, or St. Clair Shores.

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Dr. Aroras office from my first call to schedule my appointment was friendly. Walking in the first day, I felt like I was in a nice atmosphere. Dr. Arora was EXCELLENT in taking great care of my hand injury. He was gentle and very understanding to the concerns I had about my hand. His expertise was admirable and I would recommend anyone with an injury to their hand to his office to be under his care. Because of him, I have healed faster than expected and will make an 100% recovery! Thank you Dr.

Jackie S.

I first thought I was going to have to have painful injections or surgery, but Dr. Arora suggested physical therapy may do the trick. I was doubtful, but I agreed to do it. Now, my pain is gone, and with the help of an ergonomic keyboard at work to keep my hands in the correct position, I am virtually pain free. The therapy strengthened my wrists and shoulders, and built more flexibility into my wrists.

Jerry T.

My experience with this doctor was positive from the outset. Dr. Arora was kind and spent a great deal of time with me. Staff was friendly. The office was nice and bright.

Ariel G.

Very friendly and helpful Great staff!!! Doctor Arora was very professional and did great work. I was very happy with everything!

L B.