RICE & MICE: Hand fractures

Philadelphia Flyers defenseman, Chris Pronger was originally sidelined with some swelling in his hand after being hit by a puck on February 24, 2011 in a game against the New York Islanders. After x-rays failed to show a fracture, he returned to play after missing one game only to hit that same hand against the boards in a game on March 8, 2011 against the Edmonton Oilers. They are not sure if the break was initially caused by being hit with the puck in February, or if the fracture happened in the game against the Oilers, but a CT scan revealed a fracture. The Flyers organization did not specify where the fracture was in Pronger’s hand, but it was decided that a screw would be inserted to hold the bone together and expedite healing and recovery.

Hand injuries in hockey can be the result of a fight, a fall, a collision between players or a collision between a player and the boards or blunt trauma from being hit by the puck or a stick. The bones of the fingers are called the phalanges and there are in each of the little, ring, middle and index fingers and 2 in the thumb. The metacarpal bones are the five bones of the hand that sit between the fingers and the wrist bones (also called carpal bones). Injuries to the hand can include dislocations, ruptured tendons or ligaments and fractures.

Pronger is not the only NHLer to suffer a hand fracture this NHL season. Other players who have suffered broken hands include: New York Rangers forward Ryan Callahan broke his left hand while blocking a shot back in December,The Buffalo Sabres’ right winger Patrick Kaleta broke his left hand  twice this season blocking shots – once in December and once about a month later in January. Lucky for Kaleta that the puck damaged the same area of his hand. In November, Pittsburgh’s Jordan Staal was sidelined with a broken right hand.

The bones of the hand serve as points of attachments for the muscles that make the wrist and fingers move. A fracture may cause pain, stiffness, and loss of movement or weakness in common movements, such as a hockey player being able to grip his stick. Some fractures will cause an obvious deformity, but many do not. Just because you can move your fingers does not necessarily mean that there is no fracture.  

Fractures can be simple, in which the bones do not shift or move, or they can be more complex with the broken bones dislocating or displacing within the hand. Fractures that break the skin are often call compound or open fractures.

The 1st metacarpal bone, the one at the base of the thumb, is the most commonly fractured bone in the hand. A fracture of this bone can happen in a fight or fall when the hand stricks an object, the ice or the boards. The 1st metacarpal can be fractured causing the thumb to be held in a position across the palm of the hand or it can be fractured and dislocated (called a Bennett’s fracture). The severity of the fractures may or may not require surgery, but most will require re-alignment and casting for 4 weeks.

The other metacarpals may also be fractured by similar mechanisms. The metacarpals of the ring and little fingers (the 4th and 5th metacarpals) are also commonly injured in fights from punching an opponent. These fractures are commonly referred to as a boxer’s fracture. As long as the fracture is not displaced, it can be casted or splinted for 2-3 weeks.  If it is significantly displaced it will need to be set and then casted or splinted.

Fractures can happen to the other metacarpal, or hand, bones and they can happen in any part of the metacarpal bone.  Any fracture that disrupts the joint surface (articular fractures) usually needs to be set more precisely to restore the joint surface as smooth as possible. Sometimes these fractures will be set and fixated using pins, plates or screws to allow and expedite healing.

Some fractures are not detected on x-rays and will require more advanced imaging studies. In the case of Chris Pronger, the x-ray was negative and he continued having weakness in the hand so they did an MRI before a CT scan. CT scans and bone scans can pick up fractures that x-rays and MRIs may miss. The screw will help speed the healing process as well as provide extra strength to the bone to help prevent future injuries.

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