Hand & Wrist Fracture Surgery
Surgical treatment to restore function and stability after hand and wrist fractures
Fractures of the hand and wrist are common and can result from falls, sporting accidents, workplace injuries, or direct trauma. While many fractures heal with splints or casts, some are complex and require surgical treatment to restore alignment, stability, and function. Surgery may be recommended when the bones are displaced, unstable, involve a joint, or have not healed properly with non-surgical management.
When surgery may be recommended
Surgery is generally considered in cases where:
- The bone ends are significantly displaced or out of alignment.
- The fracture extends into a joint, affecting joint stability and movement.
- Multiple bones are broken, or there is associated ligament or tendon injury.
- The fracture is unstable and unlikely to heal properly in a cast alone.
- There are complications such as malunion, nonunion, or open (compound) fractures.
Surgical techniques
The choice of surgical method depends on the type, location, and severity of the fracture:
- Internal fixation – Small plates, screws, or wires are used to hold the bone fragments securely in place while they heal.
- External fixation – A stabilising frame is applied outside the body and connected to the bone with pins, often used for severe or complex injuries.
- Bone grafting – In cases where bone healing is delayed or where there is a gap at the fracture site, bone graft material may be used to stimulate healing.
The Surgical Procedure
Hand and wrist fracture surgery is typically performed under regional or general anaesthetic. The fracture is carefully realigned, stabilised with the chosen fixation method, and the surrounding tissues are repaired if needed. Dressings or a splint are applied to protect the hand during the early healing phase.
Recovery and Rehabilitation
- Early care – The hand is elevated, and gentle finger exercises are encouraged soon after surgery to reduce swelling and stiffness.
- Splinting and protection – A splint or cast may be required for several weeks while the bone heals.
- Hand therapy – Specialised rehabilitation is an important part of recovery. Exercises help restore movement, strength, and dexterity.
- Healing time – Most fractures take 6 to 12 weeks to unite, although full recovery of strength and motion may take longer.
Long-Term Outcomes
The aim of surgery is to restore bone alignment, protect joint function, and allow patients to return to their usual activities as safely as possible. While most people regain good function, outcomes depend on factors such as the severity of the fracture, the type of fixation used, and adherence to rehabilitation. Prof Sallen will provide individualised advice about your recovery and long-term expectations.
Risks and Complications
All surgical procedures carry some risks. While most people recover well after hand and wrist fracture surgery, it is important to be aware of potential complications. These include:
- Infection – Wound infection or, rarely, infection involving the bone or fixation hardware.
- Bleeding and swelling – Some bruising and swelling are expected, but in rare cases bleeding or haematoma may occur.
- Nerve or blood vessel injury – Because nerves and vessels lie close to the bones, there is a small risk of damage during surgery, which may lead to numbness, tingling, or altered circulation.
- Stiffness and loss of motion – Scar tissue and prolonged immobilisation can limit movement of the fingers, wrist, or hand. Hand therapy is often recommended to reduce this risk.
- Delayed healing or nonunion – In some cases, the bone may heal slowly or fail to heal fully, sometimes requiring further surgery.
- Malunion – The bone may heal in a less-than-ideal position, which can affect function or appearance.
- Problems with fixation devices – Plates, screws, or wires can occasionally loosen, break, or irritate surrounding tissues, and may need removal.
- Persistent pain or weakness – Although surgery aims to restore comfort and function, some people experience ongoing symptoms, especially after severe or complex fractures.
- Complex regional pain syndrome (CRPS) – A rare condition involving persistent pain, stiffness, and swelling after injury or surgery.
Prof. Sallen will discuss these risks with you in detail before surgery, explain how they are managed, and provide strategies to support safe recovery and rehabilitation.