Bone and joint alignment in the hand are very important to allow for full range of motion. A fracture in the hand, whether it involves the joint space or not, can force the entire hand out of alignment and decrease the ability to participate in everyday activities due to decreased mobility. There are 19 bones in the hand, 5 metacarpals, 5 proximal phalanges, 4 middle phalanges, and 5 distal phalanges, in addition to 19 joints, 5 Carpometacarpal joints (CMC), 5 Metacarpal Phalangeal joints (MP), 4 Proximal Interphalangeal joints (PIP), 4 Distal Interphalangeal joints (DIP), and 1 Interphalangeal joint (IP) in the thumb. A fracture is a crack in the bone and can be in alignment or displaced (out of alignment). There are also closed fractures and open fractures, where the skin is broken by the fractured bone. Surgery may be required if the bones are displaced, especially if it causes changes to the joint space, or if there is an open fracture.

• Direct trauma to the hand
• Fall
• Sports injuries
• May be more susceptible if you have osteoporosis

• It is impossible to entirely prevent accidents
• Ensure you have good bone strength by avoid smoking, having a good diet, and exercise regularly
• Prevent falls by having a safe environment, avoid walking in snow and ice, wear appropriate footwear, use assistive devices if you have difficulty with balance

• X-rays are the main test to determine if there are fractures in the bones
• Sometimes, CT Scans are done to determine the alignment of the fracture to determine if surgery is needed
• Palpation of the hand and fingers to determine where tenderness exists

• If the bones are aligned and the fracture does not affect the joint space, immobilization in a cast or splint is the treatment of choice
• If the fracture pieces are not aligned, a manipulation or reduction of the fracture may need to be performed before casting to align the bones for immobilization
• Surgery may be necessary if the fracture cannot be reduced or shifts after being immobilized, there is an open fracture, the bone is in multiple fragments, the joint space is compromised, there is damage to surrounding structures like ligaments, blood vessels, or tendons
• Medications for pain

• Sometimes, in non-displaced fractures that are determined to be stable by the physician, range of motion can be started immediately
• Range of motion exercises provided following immobilization or surgery
• Tendon gliding exercises
• Scar management if surgery is performed
• Custom splinting whether non-operative or post-operative
• Strengthening following fracture healing
• Modalities like heat, ice, and paraffin for pain