Bone, Joint and Muscle Conditions
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).
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.
An injury that breaks a bone may also damage a child’s growth plates or soft tissues that are near the bone or connect to the bone, such as skin, ligaments or tendons. Damage to growth plates or soft tissues may affect the way doctors treat your child’s fracture.
Types of fractures
There are several types of fractures:
- 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.
- Traumatic fractures occur due to injury, such as falling while running, biking or riding a skateboard. The bone gets more force than it is able to handle, and it breaks. Most fractures are traumatic.
- Stress fractures can happen when a child or teen repeats the same position or motion over and over for long periods of time. Stress fractures are not common.
- Pathologic fractures occur because the bone is weaker than normal. This is usually due to holes in the bone (bone cysts) or certain bone conditions, such as brittle bone disorder (osteogenesis imperfecta), in which bones break easily. This is not a common cause of fractures.
Hand Fractures in Children and Teens
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.
Children are flexible, so 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 bone 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 and affect the bone’s ability to grow.
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 the growth plate is damaged by a fracture or another injury, 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.
Hand Fractures at Seattle Children’s
At Seattle Children’s, we understand children’s and teens’ growing bones. We have the knowledge and experience to provide expert fracture care, including surgical treatment of the most complex cases.
We treat about 2,000 children and teens with fractures each year. In the summer, when children play the hardest, we see many fractures on our busiest days. Many of the patients we treat are referred to us from other doctors and hospitals throughout the Pacific Northwest.
Learn more about our Fracture Program, which handles fractures and growth-plate injuries, and our Hand and Upper Extremity Program, which focuses on hand and arm conditions, including fractures.
Our fracture team is led by surgeons who specialize in the treatment of children’s bones, muscles and joints (pediatric orthopedists). The team also includes physician assistants, orthopedic technologists, nurses and pediatricians trained in sports medicine. Their goal is to get your child back to their usual activities as quickly as possible. To restore or improve your child’s health, function and quality of life, we often use nonsurgical methods (like splints or casts), recommending surgery only when we believe it will give your child the best results.
Many of our pediatric orthopedic surgeons have expanded fellowship training.
We have the largest group of board-certified pediatric radiologists in the Northwest. Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image. We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.
We see your child as a whole person. Infants, children and teens are still developing, so they may need different care than adults do, like treatment that takes their growth plates into account. Here, your child’s team has special training in the medical, surgical, emotional and social needs of young people.
Symptoms of Hand Fractures
Some signs of broken bones are clear – for example, when the bone breaks through the skin in an open fracture. Other signs that bones may be broken and growth plates injured include:
- Severe pain.
- Swelling, bruising or bleeding.
- Bone or joint that looks out of place or the wrong shape.
- Weakness, numbness or tingling.
- Trouble moving the part of the body that is broken.
- 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 or the emergency room.
Diagnosing Hand Fractures
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, like damage to the fingernail, tissue under the nail (nail bed), ligaments, tendons or joints.
If 1 or more bones might be fractured, your child will need X-rays. This helps us know how to treat your child. 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 require surgery. Knowing when a child’s fracture needs surgery requires special education and experience with pediatric trauma.
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 MRI (magnetic resonance imaging) scan or other scan to check for growth-plate damage.
Treating Hand Fractures
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 consider many other factors, such as these:
- Whether the broken bone is lined up in a normal way or is out of position (displaced)
- Whether 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 require surgery. Hand fractures can happen and heal differently in children than in adults.
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 which bone they broke and how severe 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 the broken body part is bumped or moved.
If your child’s X-ray shows their fractured bone is at an angle or in a bad position, 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). In some cases, we use pins to keep the bone in place so it can heal correctly. Later we take out these pins at a clinic visit.
Most children with hand fractures do not need surgery. If your child does need an operation, our surgical staff can ensure that they receive the most appropriate 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 to adjust the length of a bone or other care.
If you have questions about treatment of hand fractures, call our Orthopedics and Sports Medicine Department at 206-987-2109. If you would like an appointment, ask your child’s primary care provider for a referral.
Providers, see how to refer a patient (PDF).