The palm of the hand can be broken, an injury that falls under the general classification of a hand fracture. These types of breaks are common skeletal injuries, given the hand’s complex structure and constant involvement in daily activities. Due to the high forces the hand often withstands, such injuries can significantly impair function if not treated correctly.
Which Bones Make Up the Palm?
The main structure of the palm is built upon five long bones called the metacarpals, which bridge the wrist bones to the fingers. These bones are numbered one through five, starting with the metacarpal connected to the thumb and ending with the one leading to the little finger. They provide the framework for the hand’s arched shape and stability.
A fracture in the palm most commonly involves one or more of these five metacarpal bones. While the metacarpals form the core of the palm, the eight small carpal bones of the wrist are also located near the base of the palm and can be broken. The long, slender nature of the metacarpals makes their neck and shaft particularly susceptible to fracturing from direct impact forces.
Common Causes of Palm Fractures
One of the most frequent ways the palm is broken is through a direct impact, such as punching a solid object with a closed fist. This mechanism often results in a “Boxer’s fracture,” which is a specific break occurring at the neck of the fifth metacarpal. The fracture happens where the metacarpal bone meets the knuckle joint, causing the bone end to angulate or displace.
Palm fractures are also commonly sustained during a fall where a person lands on an outstretched hand. This sudden, compressive force travels from the wrist bones into the metacarpals, leading to a break in the bone shaft or base. Another significant cause involves crush injuries, where the hand is compressed by heavy machinery, a car door, or other dense objects. These high-energy traumas can result in complex fractures where the bone is shattered into multiple fragments.
Recognizing the Signs of a Hand Fracture
The immediate indication of a palm fracture is typically a sudden and severe level of localized pain that often intensifies with any attempt to grip or move the hand. This pain does not subside quickly and may feel deep and throbbing as time passes. Swelling near the injury site begins rapidly and can become significant, making the hand appear noticeably larger than the uninjured one.
A visible deformity is a strong sign of a break. In some severe cases, a rotational deformity may be present, where the injured finger overlaps the adjacent finger when trying to make a fist. This misalignment is particularly concerning because it can lead to long-term functional problems if not corrected. Any combination of these symptoms following a significant trauma warrants immediate medical attention.
Key Symptoms
- A finger appearing crooked or shortened compared to the others
- A sunken or depressed knuckle when the hand is clenched, indicating a displaced metacarpal fracture
- Extreme tenderness to the touch over the broken bone
- Difficulty or an outright inability to move the affected fingers or form a complete fist
Treatment and Recovery Timeline
The diagnostic process begins with a medical examination and is confirmed through X-rays, which are necessary to visualize the fracture type and the degree of bone displacement. Treatment for a palm fracture is divided into non-surgical and surgical approaches, depending on the stability and alignment of the broken bone segments. Stable fractures that are not significantly displaced are typically treated non-surgically with immobilization, which involves placing the hand in a cast or a splint for three to six weeks.
More complex injuries, such as those with significant displacement, rotational deformities, or multiple fragments, often require surgery to realign the bones. During this procedure, the surgeon uses pins, wires, or screws to hold the fragments securely in place while the bone heals. After the period of immobilization, the bone has achieved initial healing within six to eight weeks to begin rehabilitation. Physical therapy is then required to address stiffness and restore full strength and range of motion to the hand, with a full return to high-impact activities generally taking three to six months.