Upper Extremity Fractures

The surgeons at the Center for Hand and Upper Extremity Surgery are fellowship-trained hand and upper extremity experts with years of focused training in treating simple and complex fractures. From realigning and stabilizing bone structure to addressing tendon or nerve damage, our advanced surgical procedures restore mobility and sensation. 

Wrist Fractures

Wrist fractures account for around 10% of all broken bones. The wrist is made up of eight small bones that connect with the two long forearm bones called the radius and ulna. Some wrist fractures can be treated with a cast, while others may need surgery to return the bones to their correct position. 

Distal Radius Fractures

The most common fracture of the wrist is a distal radius fracture. A distal radius fracture can range from simple to complex, involving the wrist joint and possibly other tissues like tendons or nerves. Typically caused by falls, especially onto an outstretched hand, these fractures lead to significant pain, swelling, and possible deformity, with potential numbness or tingling in the fingers. 

Hand and Finger Fractures

A fracture is the medical term for a broken bone. The hand is made up of nineteen small bones that are at the end of the wrist and the forearm, and a fracture can involve any of these small bones. Some fractures can be treated with a cast, and others will need surgery to return the bones to their correct position.

Metacarpal Fractures

A metacarpal fracture, the most common hand fracture (often caused by direct hand impact), can vary from simple to complex, involving major joints or other tissues like tendons and nerves. Typically triggered by trauma, these fractures result in considerable pain, swelling, and potential deformity, affecting hand and wrist movement. 

 

Non-Healing Fractures

Non-Healing Fractures, also known as non-unions, occur when a bone fails to heal within the expected time frame or doesn't heal properly due to various factors like inadequate blood supply, infection, or instability. In these cases, medical intervention may be necessary to promote healing, which can involve surgical procedures such as bone grafts to stimulate new bone growth or the use of specialized devices to stabilize the fracture site. Timely and appropriate treatment is crucial to prevent long-term complications and restore optimal function to the affected bone.

Scaphoid Nonunion

Scaphoid nonunion is one of the most common non-healing fractures we see. This occurs when the scaphoid bone, a small bone that belongs to the carpal tunnel bones that make up the wrist joint, does not heal properly after a fracture. 

Distal Radius Nonunion

Distal radius nonunion is when a fracture at the lower end (distal part) of the radius bone in the forearm fails to heal properly.

Ulna Non-Union

Ulna nonunion occurs when a break in the ulna bone, one of the forearm bones, doesn't heal properly. 

Humerus 

Fractures in the humerus, a bone in the upper arm, can sometimes face challenges in healing, causing nonunion. 

 

 

Treatments for Fractures and Nonunion

Despite how common broken wrists, hands, and fingers are, not all fractures are treated the same. If left untreated, a broken bone can lead to complications such as improper healing, loss of function, chronic pain, stiffness, and, in severe cases, long-term disability. First-line treatment for wrist, hand, and finger fractures typically involves realigning the bones using splints or casts. In severe or complex cases, the surgical placement of pins, rods, and plates may be needed to stabilize the bones. The overarching goal of treatment is to promote proper healing, restore function, and minimize long-term complications.

Non-Surgical Treatments

Immobilization (Splinting or Casting)

This involves aligning the broken bones and then immobilizing them with a splint or cast to allow the fracture to heal properly.

Closed Reduction

This procedure involves manipulating the bones back into their proper position without surgery. It's typically done in the ER or doctor's office under local anesthesia.

Physical Therapy

Once the initial healing phase begins, physical therapy helps restore strength, flexibility, and range of motion to the affected area. Adhering to a physical therapy regimen is crucial for regaining function after the immobilization period.

 

Surgical Treatments

Complex Hand Reconstruction

Complex hand reconstruction is often needed for injuries that involve severe damage to the structures of the hand and fingers, including the bones, nerves, tendons, and soft tissues. In cases involving crush injuries, multiple fractures, injuries that strip away skin and soft tissues (degloving injuries), or amputation, intricate surgical procedures are required to rebuild the structures of the hand and restore function, appearance, and mobility. The surgeons who perform such procedures undergo years of specialized training in microsurgery, tissue transfers, tendon re-arrangement, nerve reconstruction, fracture fixation, and joint replacement.

When fractures experience delayed union or nonunion, meaning the bones do not heal as expected, various treatment options are available to stimulate the healing process. The approach to treatment depends on factors such as the type of fracture, its location, and the individual's overall health. 

Open Reduction and Internal Fixation (ORIF)

ORIF involves surgically realigning the fractured bones and securing them in place with internal fixation devices such as screws, plates, or rods. This provides stability and facilitates proper healing.

Revision Surgery

Revision surgery is a subsequent surgical procedure performed to address complications, inadequate healing, or persistent issues following a previous surgery. The goal is to increase function, alleviate pain, and improve the outcome of the initial fracture management.