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Fracture surgery
Most hand and wrist fractures are treated without an operation. Where surgery is needed, the aim is the same in every case: to put the bone back in a position that lets the hand work, and to hold it there while it heals.
This page covers the fracture operations performed at Melbourne Hand Surgery, and how to be assessed quickly, including by telehealth through the Melbourne Hand Surgery’s Online Fracture Assessment. For the conditions themselves, see hand and wrist fractures.
At a glance
Not every fracture needs surgery
Most hand and wrist fractures are treated without an operation. Assessment comes first
Anaesthetic
General anaesthetic at The Avenue Hospital
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately one week after surgery
Post operative hand therapy
Required
Putting the bone back where it belongs, and holding it there
Fracture surgery restores the position of the broken bone and fixes it there so it heals in a position that lets the hand function. The fixation used depends on the bone, the pattern of the break, and whether the fracture involves a joint. It may be wires, screws, a plate, or a combination.
The operation is only part of the treatment. What happens in the weeks afterwards, particularly the movement and rehabilitation programme, has as much to do with the final result as the fixation itself.
Who is this surgery for?
- Fractures where the fragments are out of position in a way that would affect how the hand works
- Fractures that are unstable and likely to move if treated in a splint or cast alone
- Fractures that run into a joint surface, where a step in the cartilage would lead to stiffness or arthritis
- Fractures that have failed to unite, known as non-union
Whether any of these applies to you can only be judged from your images and your examination. Many fractures that look dramatic on an X-ray are perfectly well treated in a splint, and some that look minor are not.
Fracture operations we perform include
- Distal radius fracture surgery
Fixation of a broken radius at the wrist, most often with a plate and screws. - Scaphoid fracture surgery
Fixation of a fractured scaphoid, usually with a screw, and surgery for scaphoid non-union. - Metacarpal fracture fixation
Fixation of a broken bone in the palm, using wires, screws or a plate. - Phalangeal fracture fixation
Fixation of a broken finger or thumb bone. - Mallet finger fracture repair
Surgery for a mallet fracture, where a fragment of bone is pulled off at the base of the fingernail joint and the fingertip droops.
Each page sets out what that operation involves, the specific risks, the recovery, and the aftercare. If you are not sure which applies to you, start with hand and wrist fractures.
What does the surgery involve?
The broad shape is the same across fracture operations, although the detail differs by bone and by fracture pattern.
- The fracture is exposed, or in some cases manipulated into position without opening the skin.
- The fragments are restored to position under direct vision and X-ray guidance.
- The position is held with wires, screws, a plate, or a combination, chosen for that bone and that fracture.
- The wound is closed and a dressing or splint applied.
- Movement is started at the point appropriate to the fixation used, guided by a hand therapist where needed.
Some fixation is designed to be removed later, particularly wires. Some stays permanently. This is discussed with you before your operation, and is set out on the individual procedure pages above.
Alternatives to surgery
Surgery is one option for a hand or wrist fracture, and for most fractures it is not the one chosen. Depending on your situation, the alternatives may include:
- Splinting or casting. A well-positioned, stable fracture is protected while it heals, with review to confirm the position has been maintained. This is the commonest treatment.
- Buddy strapping and early movement. Used for some finger fractures, where moving the finger early is what prevents stiffness.
- Closed reduction. The fracture is manipulated back into position without an incision, then held in a splint or cast.
- Hand therapy alone. Guided movement and swelling management, where the fracture position is acceptable and the risk is stiffness rather than displacement.
- Accepting the position. Some displacement is tolerated well and does not affect how the hand works. Operating on it would add risk without adding benefit.
What happens if a fracture that needs surgery is left untreated: the bone heals in the position it is in. Depending on the fracture, that can mean a finger that crosses its neighbours, a stiff or painful joint, reduced grip, or in the case of the scaphoid, a bone that does not heal at all and goes on to cause wrist arthritis.
Dr Tomlinson will discuss which options suit you at your consultation. For a fuller explanation of all treatment options, see hand and wrist fractures.
Assessment without the drive: the Melbourne Hand Surgery's Online Fracture Assessment
The first question with any new fracture is whether it needs an operation at all. Melbourne Hand Surgery runs the Melbourne Hand Surgery’s Online Fracture Assessment so that question can be answered without travelling.
It is a rapid-access telehealth clinic. Your fracture and your imaging are reviewed by a hand surgeon in a video consultation, and you are given a clear opinion on what your fracture needs. Referral to an accredited hand therapist is arranged if required.
It is of particular benefit to regional and rural patients. Access to a hand surgeon can be challenging outside metropolitan Melbourne, and the distance to travel is significant. That is true at any time and worse when the hand in question is fractured, swollen and splinted, and when you may not be able to drive yourself. The virtual clinic removes that trip for the assessment. If an operation does turn out to be needed, you travel once, for the operation, rather than twice.
- Who it is for: adults and children aged 10 and over with a recent, new hand fracture, including fractures of the fingers, thumb, metacarpals and carpal bones such as the scaphoid.
- What it does not cover: distal radius (wrist) fractures. For those, see distal radius fracture surgery or contact us directly.
- Cost: this is a private clinic. Payment is required for your appointment. See fees and informed financial consent.
Frequently asked questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves and which fracture was fixed. If your work is desk-based or administrative, you may be able to return relatively soon, often with some temporary modifications. If your work is physical, involving heavy lifting, manual labour or being on tools, you will usually need longer, because a healing fracture cannot be loaded until it has united.
Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you are wearing a bandage or splint, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You also need to be safely in control of the vehicle for insurance purposes. You should be able to grip the steering wheel strongly with both hands and take evasive action in an emergency before you get behind the wheel.
Plan not to drive for six weeks after the procedure, once your fracture is confirmed to have healed.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We are happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity). How does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance you will be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication, and your anaesthetist will give you specific instructions.
Will the metalwork need to be removed later?
It depends on what was used. Wires that sit outside or just under the skin are designed to be removed once the fracture has united, and removal is usually a short procedure. Screws and plates are generally left in place unless they cause a problem, such as irritation of a tendon or discomfort over a prominent edge.
How long will I need to wear a splint?
The general principle is that the splint protects the fixation until the bone has healed enough to be loaded, while allowing whatever movement the fixation permits. Immobilising a hand for longer than necessary causes stiffness, so the timing is a balance.
Will I need to see a hand therapist afterwards?
Yes, hand therapy is an important part of recovery after fracture surgery. A hand that has been immobilised stiffens, and guided movement is how that is prevented and reversed.
What pain medication will I need afterwards?
Usually simple pain relief, paracetamol and ibuprofen, is all that is needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks and complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain, usually temporary, occasionally persistent
- Swelling, common, and usually settles over weeks to months
- Scarring, scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS), an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance, the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE), uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of fracture surgery
In addition to the general risks of hand surgery, fracture surgery carries risks relating to the bone and the fixation:
- Failure of the fracture to unite (non-union)
- Healing in an imperfect position (malunion)
- Loosening, migration or breakage of wires, screws or plates
- Metalwork that becomes prominent or irritates a tendon, and may need removal
- Stiffness of the adjacent joints
- Later arthritis, particularly where the fracture involved a joint surface
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Want to know more about fracture surgery?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.