Avulsion Fracture of the Hand

What is an Avulsion Fracture of the Hand

Avulsion fracture of the hand is a tearing away of a piece of bone in the hand. Bones are connected to other bones by strong bands of tissue (ligaments).

Muscles are also connected to bones with strong bands of tissue (tendons). Avulsion fractures occur when severe stress on a ligament or tendon causes a small piece of bone to be pulled away from the main portion of the bone. This is typically caused by trauma or injury.

What are the causes?

This condition may be caused by:

  • Falling with your hand outstretched.
  • A sports injury.
  • An injury in which a thumb or finger is jammed against a hard surface.

What increases the risk?

You are more likely to develop this condition if:

  • You participate in activities during which falling is more likely, such as:
    • Gymnastics.
    • Skiing.
    • Ice-skating.
  • You participate in activities during which jamming your thumb or finger is more likely, such as basketball or volleyball.
  • You have a job or participate in activities in which sudden force may hit one or more fingers, such as:
    • Football.
    • Construction work.
    • Carpentry.
    • Factory work.
  • You have had diabetes for many years.
  • You have osteoporosis.

What are the signs or symptoms?

The main symptom of this condition is intense pain at the time of injury. You may also feel a pop or tearing. The pain continues after the injury. Other signs and symptoms may include:

  • Swelling.
  • Bruising.
  • Pain with movement.
  • Pain when pressure is applied to the injured area.
  • The injured area feeling warm to the touch.

How is this diagnosed?

This condition may be diagnosed by:

  • History. Your health care provider will ask you what occurred during the time of your injury and whether you had any pain in the area before your injury.
  • Physical exam. During the exam, your health care provider may try to move your hand, fingers, and wrist:
    • To check for pain.
    • To check how much movement you can tolerate.
    • To check how stable the injured part of your hand, finger, or wrist is.
  • X-ray. This will show if any bones are fractured or out of place (displaced).
  • MRI. This will show your tendons and ligaments. Some avulsion fractures are associated with an injury to a tendon or ligament.
  • CT scan. This will show a more detailed image of your injury than an X-ray does.

How is this treated?

Treatment for this condition depends on the size of the torn piece of bone and how far it has been displaced. Treatment options include:

  • Preventing the injured hand from moving (immobilization) by wearing a splint. The splint may need to be worn for a brief period of time or for up to six weeks, depending on the extent of your injury.
  • Rest, ice, pressure (compression), and raising (elevating) your injured hand (RICE therapy).
  • Surgery to reattach the bone to the ligament or tendon.
  • Medicines that reduce pain and swelling (NSAIDs).
  • Other treatments, such as physical therapy, to regain full use of your hand. This may last for several months.

Follow these instructions at home:

If you have a splint:

  • Wear it as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint if your fingers tingle, become numb, or turn cold and blue.
  • Keep the splint clean.
  • If the splint is not waterproof:
    • Do notlet it get wet.
    • Cover it with two layers of watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

  • Apply ice to the injured area.
    • If you have a removable splint, remove it as told by your health care provider.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag or between your splint and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Take over-the-counter and prescription medicines only as told by your health care provider.

Keep your hand raised above the level of your heart when you are resting.

General instructions

  • Rest your hand until your health care provider says you can resume activity.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as directed by your health care provider. This is important.

Contact a health care provider if:

  • Your pain gets worse.
  • You have chills or a fever.
  • You have any of these problems with your splint:
    • It is damaged.
    • It has a bad odor or is stained by fluids from your wound.
    • It still feels too tight (snug) after you loosen it.

Get help right away if:

  • Your hand is cold, blue, or pale.
  • You have pain, swelling, redness, or numbness below your splint.
  • You have numbness or tingling in your hand.
  • You have increased pain in your hand or have pain that is not relieved by pain medicine.
  • You cannot move your fingers or hand.

Summary

  • Avulsion fractures occur when severe stress on a ligament or tendon causes a small piece of bone to be pulled away from the main bone.
  • Treatment for this condition depends on the size of the torn piece of bone and how far it has been pulled out of place.
  • Rest your hand until your health care provider says you can resume activity.
  • Keep all follow-up visits as directed by your health care provider. This is important.
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