Signs and Symptoms
- Pain
- Swelling
- Bruising
- Bone doesn’t feel in normal position
- Fingers may overlap each other when making a fist
- Loss of prominence of knuckle
Diagnosis
- Having the physician take a thorough history and physical exam
- X-rays
Background
- A joint is where two or more bones come together, and muscles attach to them to allow active motion. If a bone is broken and we allow the muscles to continue acting on it, the muscles can pull the broken bone fragments apart and the bone will not heal (or will heal in a position of deformity).
- Thus, when bones are broken, the bone and corresponding joint must be immobilized through pins, plates & screws, and/or casting or bracing orthoses (“splints”). This allows the body to heal the broken bone without muscles acting on it and pulling it apart. However, when a joint is prevented from moving for several weeks, the fracture will heal but the joint is often stiff when it’s allowed to start moving again. The purpose of occupational/physical therapy is to carefully remobilize the joint without compromising the integrity of the healing bone.
- Therapy goals are to reduce swelling/pain; minimize excessive scar tissue formation; carefully return the joint to full range of motion; and ultimately restore full strength and coordination.
Treatment
Conservative (Non Surgical)
For fractures that are not significantly displaced (out of their normal position)
- Splint or cast for up to 6 weeks with hand therapy starting around week 3.
Surgery
For unstable or significantly displaced fractures
Hand Therapy
Week 0-4
By the end of 2 weeks, your soreness and swelling will be steadily decreasing. By the end of 4 weeks, you should have regained 50-75% of your range of motion (and often more, provided you are attending therapy consistently). Also, beginning at 4 weeks post-op, you will gradually reduce your splint wear based on therapist recommendations (assuming everything is progressing without issue).
Week 5-6:
- Range of motion will be approaching 100%. Soreness should be virtually gone by 4 weeks post-op, and point-tenderness at fracture site should resolve by 6 weeks post-op. When point-tenderness resolves, it indicates the fracture is healing well. At this point, it is safe to start gentle stretching and strengthening.
By the end of 6 weeks, splint wear is typically discontinued entirely. Range of motion should be virtually normal. Soreness and tenderness should be completely resolved, though residual swelling may linger. This is normal; swelling may continue to slowly improve over another 3-4 months before totally returning to normal.
Week 7-8:
- Progressive strengthening and conditioning will be emphasized, with stretching incorporated as appropriate. Your therapist will advise you on safe return to gradually more strenuous activities. High-impact occupational/recreational activities may not be appropriate until 10-12 weeks post-op; your doctor will let you know when this is ok. Therapy discharge typically occurs around 8 weeks post-op, depending on your progress. Your therapist will provide you with a final home exercise program to continue on your own.
*Progression through this timeline is dependent on fracture healing, and is up to the final discretion of the treating physician and therapist. Fracture healing is dependent on many factors, but you can expedite this process by: wearing your splint as instructed; attending therapy consistently; completing home exercises as instructed; and avoiding tobacco and alcohol.
