Hand & wrist treatment
Fracture fixation holds a broken bone in the right position while it heals, using plates, screws or wires. Most hand and wrist fractures never need it — stable, well-aligned breaks do well in a cast. What makes the hand different is why we operate on the ones we do. Alongside the usual reasons, two are particular to here: a finger fracture that has twisted will cross over its neighbour when you make a fist, however tidy the X-ray looks; and fingers immobilised for weeks stiffen badly, so fixing a fracture is often about buying early movement rather than about the bone alone.
The broken bone is restored to its proper position and held there with a plate and screws, a single screw, or fine wires, chosen for the bone and the fracture. In the wrist, the priority is often the joint surface: a break running into the end of the radius — a distal radius fracture, the commonest of all — must be restored smoothly, because a step left in that surface leads to stiffness and early wear. The scaphoid is its own problem — a small bone with a precarious blood supply that can fail to unite — a non-union — so a displaced or slow-healing one is often better fixed with a screw than left. In the fingers and hand — the metacarpals in the palm and the phalanges of the fingers — the priorities shift again: rotation must be corrected precisely, and the fixation needs to be stable enough to let movement start early, because a stiff hand can be more disabling than the fracture ever was.
Recovery after hand or wrist fracture fixation
Where the fixation is stable, guided movement often starts within days — which is frequently the reason to operate in the first place. The bone unites well before the hand feels normal: grip and full comfort keep improving for months afterwards.
Timings describe typical recoveries — which bone broke and how badly decide your own, and our specialist will set that out before you commit.
Most people arrive with one question louder than the rest. Tap yours — the straight answer is one scroll away.
For a great many hand and wrist fractures, no — and hearing that clearly matters. A stable break sitting in good position heals reliably in a cast or splint. Operating on it would add the risks of surgery without improving the result. Being told your fracture does not need fixing is not being under-treated; for those breaks it is the better treatment, and the important work becomes protecting the bone while keeping the rest of the hand moving.
Fixation earns its place where position, stability or movement is at stake. A bone significantly out of place, an unstable fracture that keeps slipping, a break running into a joint surface, several bones broken at once, a finger that has twisted, or a scaphoid that risks not uniting — these do measurably better held properly. And in the hand there is the additional reason that has nothing to do with the bone: securing a fracture well enough to start moving early can be what saves the hand from stiffening. The assessment sorts which category yours falls into, using the X-ray and, for rotation, by watching how the fingers close.
These are well-established operations, and for the fractures that need them the benefit clearly outweighs the risk. The complication that matters most in the hand is stiffness — which is somewhat paradoxical, given that avoiding stiffness is often why we operate. Fingers and wrists tighten quickly, so hand therapy and early guided movement are treated as part of the treatment rather than an afterthought, and skipping them is what leaves people disappointed.
Beyond that: infection is uncommon; a bone can occasionally be slow to unite or fail to unite, most notably the scaphoid; and small nerve branches near the incisions can leave a numb patch that usually settles. Hardware deserves its own mention here — there is little soft tissue covering these bones, so a plate can sometimes be felt, irritate a gliding tendon, or become uncomfortable with certain grips, and occasionally warrants removal later. Where swelling is severe, surgery may be timed a few days out to let the tissue settle, which is a safety decision rather than a delay.
Bone healing and hand function run on different timetables. The bone typically unites over about six to twelve weeks. But where fixation is stable, guided movement often starts within days — that early start is much of the reason to operate. Everyday tasks are usually comfortable by around three months, and grip and full comfort keep improving through to about five or six. Hand therapy runs alongside all of it. Where are you in this?
The first job is to establish position, stability and rotation. Support the hand, remove rings, elevate it and get it X-rayed — an open wound over the fracture, a numb or cold hand, or gross deformity means urgent care now. Otherwise the assessment decides cast or fixation, including checking how the fingers line up as they close, which an X-ray alone will not show.
Start moving as soon as you are cleared to, and keep everything else moving from day one. Where the fixation is stable, guided movement begins early and that is what protects the hand. Keep the uninjured fingers, elbow and shoulder mobile throughout, elevate to settle swelling, and treat hand therapy as part of the treatment rather than an optional extra.
A united bone with a stiff hand is a treatable problem, not the finished result. Movement and grip recover over months with structured hand therapy, and progress is usually still possible well after the fracture has healed. If stiffness has genuinely plateaued, or hardware is irritating a tendon, that is worth reviewing rather than accepting.
For most fixed fractures, yes — holding the bone in the right position is precisely what gives it the best chance. The great majority unite and go on to a good recovery. Where a break ran into a joint surface, restoring that surface smoothly is what protects the joint from wearing early, and it is one of the main reasons those fractures are fixed rather than left.
The honest exception is the scaphoid. Its blood supply enters from one end, so a fracture can cut off the supply to part of the bone, and it is the fracture in the hand and wrist most likely to fail to unite — particularly if it was missed early, displaced, or in a smoker. That is why a suspected scaphoid fracture is protected and re-imaged rather than dismissed, and why fixing certain ones early is worthwhile. Where a scaphoid has already failed to unite, it can usually still be treated, with bone grafting alongside fixation — a bigger undertaking than getting it right the first time, which is the argument for taking that little hollow at the base of the thumb seriously.
Not most of them — and a good clinic will say so. Fixation earns its place for specific fractures — check yours:
That is the picture where fixation is genuinely considered — and part of it is urgent. An open wound over the fracture, or a numb or cold hand, means urgent care now. Otherwise, the next step is assessment with imaging to establish position, stability and whether a joint surface is involved — plus a look at how the fingers line up as they close, because rotation does not show on an X-ray and changes the plan more than almost anything else.
Good news — a stable, well-aligned break usually does not need fixing. Most hand and wrist fractures heal properly in a cast or splint, with the important work being to keep the rest of the hand moving so it does not stiffen. An assessment confirms the fracture is stable and sets the plan. More: wrist fractures
And remember: the consultation’s job is the right answer for your fracture — including “no operation.”
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A minority of them. Most breaks in the hand and wrist are stable and well aligned, and heal perfectly well in a cast or splint. Fixation is considered when the bone is significantly out of position, when the fracture is unstable and keeps slipping, when it runs into a joint surface and would otherwise heal with a step in it, when several bones are broken, and — particularly in the fingers — when the break has twisted so the finger no longer lines up. The scaphoid is its own case, because its blood supply is precarious and a displaced or slow-healing one is often better fixed early.
Because a finger that heals rotated is a functional problem even when the X-ray looks acceptable. The fingers do not close in parallel — they converge as you make a fist — so a small twist through a broken bone means that finger crosses over or under its neighbour when you grip. That is far more disabling than a few degrees of angulation, and it is easy to miss on an X-ray, which shows the bone from two flat angles and not the way the hand actually closes. It is checked by looking at the fingers as they bend, and it is one of the clearest reasons to fix a finger fracture.
In the hand, often because of stiffness rather than the bone. Fingers immobilised for weeks stiffen quickly, and a stiff hand can be more disabling than the original injury — the bone unites but the hand does not work. Fixing a fracture holds it securely enough that guided movement can start early, which is frequently the whole reason to operate. It is a different logic from larger bones, where the question is mostly whether the fracture will hold its position. Here it is often: will this hand still move by the time the bone has healed?
The bone usually unites over about six to twelve weeks, but that is only part of it. Where fixation is stable, guided movement often begins within days rather than weeks, which is much of the point. Everyday tasks are usually comfortable by around three months, while grip and full comfort continue improving through to around five or six months, sometimes longer after a complex injury. Hand therapy is central rather than optional — in the hand, the work of restoring movement matters as much as the operation that restored the bone.
Usually not. Most hardware in the hand and wrist stays in place permanently and causes no trouble. That said, removal is somewhat more common here than in larger bones, because there is little soft tissue covering these bones — a plate can be felt under the skin, irritate a tendon gliding over it, or become uncomfortable with certain grips. Where that happens, it can be removed once the bone has fully healed, as a smaller second procedure. It is a choice rather than a necessity for most people, made only if the hardware is genuinely causing symptoms.
Related: wrist fractures · wrist sprains · mallet finger · all hand & wrist surgery · physiotherapy
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