Hand Fractures

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What are hand fractures?

Fractures are cracks or breaks in bones. Children and teens may break their finger or thumb bones (phalanges, fah-LAN-jeez), their wrist bones (carpals) or the long bones between their fingers and their wrist (metacarpals).

An injury that breaks a bone may also damage a child’s or that are near the bone or connect to the bone, such as skin, or . Damage to growth plates or soft tissues may affect the way doctors treat your child’s fracture.

Because children are flexible, their bones may bend after a break. They may straighten out as they heal. This process is called remodeling.

Because of remodeling, a young person’s broken hand will heal better and with less treatment than a similar break in an adult. But some fractures that look simple to treat can cause serious problems for children or teens because their growth plates have been damaged.

Growth plate injuries

In every child’s and teen’s bones, growth occurs at specific points called growth centers or growth plates. Often, these points are near the ends of the bone.

If a fracture or other injury damages the growth plate, the bone may stop growing. This serious problem is called a growth arrest. Growth arrest can permanently stop a bone’s development and change how it functions. If only part of the growth plate is damaged and stops working, the bone may grow in an uneven way.

When is a fracture an emergency?

Call 911 or take your child to our Emergency Department if you think they may have broken a bone and the body part looks bent, curved or deformed. Other reasons to get emergency care for a fracture include:

Blood flow to the area seems lower than normal. One sign of this is a change in skin color. Your child’s skin may look paler than usual. In those with light skin tone, the area may look white. In those with brown skin tone, it may look yellow-brown. In those with dark skin tone, it may look ashen or gray. Another sign of lower blood flow to an arm or leg is that the hands and fingers or feet and toes may feel cold to the touch compared to an area above the break.
Not being able to use their hand.

For fractures that aren’t an emergency, call your child’s doctor, Orthopedics and Sports Medicine at 206-987-2109 or an urgent care clinic.

Types of fractures

Fractures can be simple or open:

Simple fractures are breaks or cracks in the bone that do not break through the skin.
Open fractures are breaks in which the bone sticks through the skin.

What causes fractures?

Fractures are very common in children and teens. About half of all boys and a quarter of all girls break a bone sometime before adulthood.

Traumatic fractures happen due to injury, such as falling while running or riding a bike or skateboard. The bone breaks because it gets more force than it can handle. Most fractures are traumatic.
Stress fractures can happen when a child or teen repeats the same position or motion over and over for a long time. Stress fractures are not common.
Pathologic fractures happen because the bone is weaker than normal. A pathologic fracture is usually due to holes in the bone (bone cysts) or certain bone conditions, such as brittle bone disorder (), in which bones break easily. This is not a common cause of fractures.

Most hand fractures happen when:

A child falls on their hand
Their hand gets twisted, bent or smashed
The child hits (or is hit by) something hard
In toddlers, breaks often happen when the tip of their finger gets caught in a door
Older children tend to get breaks during sports or other active play

Fracture Treatment at Seattle Children's

The team in Seattle Children’s Fracture Program is specially trained to diagnose and treat broken bones and other serious injuries, such as skin wounds or concussions, in children and teens.

What are the symptoms of hand fractures?

When your child or teen breaks a bone, they will have pain at the site of the break. It will be hard for them to move the body part that is broken. This pain and loss of movement are your cues to take them to the doctor, an urgent care clinic or the Emergency Department.

Signs of broken bones
Some signs of broken bones are clear — for example, when the bone breaks through the skin in an open fracture. Other signs that a bone may be broken and a growth plate may be injured include:
- Severe pain
- Swelling, bruising or bleeding
- Bone or looks out of place or the wrong shape
- Weakness, numbness or tingling
- Trouble moving the part of the body that is broken

How are hand fractures diagnosed?

First, we examine your child. During the exam, the doctor checks how the bones line up when your child moves their hand, if they can, and when the doctor tries to move it. The doctor also looks for related injuries. For example, they will look for damage to the fingernail, tissue under the nail (nail bed), ligaments, tendons or .

If 1 or more bones might be fractured, your child will need . This helps us know how to treat your child’s injury. Most likely your child will have X-rays from 3 angles so the doctor can see clearly where the break or breaks are.

Diagnosing complex fractures

Careful diagnosis is important. Simpler breaks can be treated with a splint or a cast. More complex breaks may need surgery. Knowing when a child’s fracture needs surgery requires special education and experience with fractures in children.

If the bone is broken at or near a growth plate, the doctor may suspect the growth plate is injured. The growth plate itself can’t be seen on an X-ray, but some signs of damage may show up. Sometimes children need an or other scan to check for growth-plate damage.

How are hand fractures treated?

Your child’s treatment will depend on which bone they broke and which type of fracture they have. The finger and thumb bones, the wrist bones (carpals) and the long bones between the fingers and wrist (metacarpals) can break in several ways.

Your child’s doctor will take many other factors into account, such as these:

If the broken bone is lined up in a normal way or is out of position (displaced)
If the broken bone is stable or it moves out of place easily
How old your child is, because their stage of growth may affect how their bone heals

Nonsurgical Treatment Options for Hand Fractures

To get the best results, it’s important not to do more or less than needed. Most children’s hand fractures heal fine with simple methods, like splinting or casting. Some need surgery. Hand fractures can happen and heal differently in children than in adults, so the care we recommend for your child may be different than the care for an adult.

Splinting, buddy taping and casting

If your child’s X-ray shows a fracture but the bone is straight and in a good position, we may give them a splint to keep the bone in place while it heals.

For some breaks, buddy taping is an option. Buddy taping means taping 2 fingers together to keep broken fingers from moving too much. Sometimes a splint or buddy taping is all that your child needs while the bone heals.

Based on the bone and how serious the break is, we may need to put a cast on once swelling is under control. We apply casts if we think the bone may not heal well unless it stays in 1 position.

We also use casts if they can make your child more comfortable by keeping the broken bone still. This reduces the pain that comes if your child bumps or moves the broken body part.
Moving the bone back into place (fracture reduction)

If your child’s X-ray shows their fractured bone is at an angle or in a bad position for healing, the doctor will try to move the bone back into place (fracture reduction) before splinting, taping or casting. The doctor may be able to do this just by using their hands to move your child’s finger or hand (closed reduction). Before reduction, we give your child medicine to block feeling around their fracture (anesthesia) or to relax them (sedative).

Surgery for Fractures

If the doctor can’t move the bone back into place just by using their hands (closed reduction), your child may need surgery.

The surgeon will make a small cut (incision) so they can see the fracture and move the bone (open reduction). Sometimes, we use pins to keep the bone in place so it can heal well. Later we take out these pins at a clinic visit.

Most children with hand fractures do not need surgery. If your child needs an operation, our surgical staff will carefully choose the best surgery for their injury.

Dealing With Growth-Plate Injuries

Most growth-plate injuries will heal without affecting growth. The risk of problems depends on many factors, such as how serious the injury is, how old your child is and which bone they broke.

If your child has or might have a growth plate injury, the doctor will ask you to watch for signs of growth problems. The doctor will also want your child to come back from time to time in the first 1 to 2 years after the injury. The doctor will examine your child, and your child may have X-rays to check for growth problems. For example, the finger that was broken may not be growing as fast as the other fingers or it may not be growing straight.

Some children who develop growth problems may need surgery, such as to adjust the length of a bone, or other care.

Why choose Seattle Children’s for hand fracture treatment?

Seattle Children’s Fracture Program specializes in fractures and growth plate injuries in children and teens. Our Hand and Upper Extremity Program focuses on hand and arm conditions, including fractures. Both programs are part of Orthopedics and Sports Medicine.

Our goal is to get your child back to their usual activities as quickly as possible.

The fracture experts you need are here
- At Seattle Children’s, your child’s team includes , pediatric , , , nurses, , certified , registered and .
- We have the knowledge and experience to give your child expert fracture care, from a splint or cast, to complex surgery, to rehabilitation. Many of the children we treat are referred to us from other doctors and hospitals throughout the Pacific Northwest.
- We treat about 5,800 children and teens with fractures each year and see 20 fractures on our busiest days. Many kids we see were hurt in sports or other active play.
Injury care for growing bodies
- Kids are still growing well into their teens. This means their bodies can be damaged in ways that an adult body can’t. At Seattle Children’s, we specialize in knowing which treatments are most likely to have the best results for kids whose bones are still growing. The treatment we give your child will take their growth plates into account.
- All of our caregivers have special training in the physical, emotional and social needs of young people.
- Seattle Children’s has the largest group of pediatric radiologists in the Northwest. We keep your child’s safety in mind at all times. If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a 3D low-dose radiation X-ray machine, called the EOS. It makes safer full-body 3D images.
- We see your child to check their progress as their fracture heals to help prevent, watch for and deal with problems that can develop later.
Our approach to surgery aims to get the best results for your child
- We can treat most fractures successfully without surgery, but your child might need surgery if the broken bone is at an angle and in a bad position for healing.
- Before we recommend surgery, we look at your child as a whole person. Your child’s team will take many factors into account. These include where their fracture is, how serious it is, whether their growth plate was injured and what results you can expect from treatment.
- We recommend surgery only when we believe it will give your child the best results. If your child needs surgery, our pediatric have many years of experience in treating children with fractures. We have surgeons with expanded fellowship training in upper extremity surgery.
Here when and where you need us
- Seattle Children’s Emergency Department and urgent care clinics see children with broken bones.
- Our Orthopedics and Sports Medicine doctors also see patients with fractures in clinic at Seattle Children’s locations in Seattle, Bellevue, Everett, Federal Way, Olympia, the Tri-Cities, Wenatchee, Yakima and Alaska.
- Children, teens and young adults who need surgery get expert care at our hospital campus in Seattle or in Bellevue.
Support for your whole family
- Having a child with a fracture can be stressful for the whole family. From the first visit to follow-up, our team will work to give your child seamless care and make your experience here as easy on you as we can.
- Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s injury and treatment options. We support you in making choices that are right for your family.
- Seattle Children’s supports your family with a range of resources. Our Child Life specialists, Family Resource Center and Guest Services are here to help.
Research and advances to improve care
- Our surgeons have led research to reduce your child’s exposure to radiation from imaging tests, like and .
- As part of our constant work to improve results for kids, we developed standard plans (called protocols) to help your child recover after surgery.
- Learn more about current orthopedics research at Seattle Children’s.