On this page
Fractures
A fracture is a broken bone. Melbourne Hand Surgery treats fractures of the fingers, thumb, hand and wrist, and runs the Melbourne Hand Surgery’s Online Fracture Assessment, a telehealth clinic for people anywhere in Victoria with a new hand fracture.
Most hand and wrist fractures do not need an operation. What matters is that the fracture is assessed early, because the decisions that affect long-term hand function are usually made in the first week or two.
What is it?
The hand and wrist contain 27 bones. A fracture can involve any of them, and the right treatment depends on which bone is broken, where the break sits, whether the fragments have moved, and whether the fracture enters a joint.
Because the answers differ so much between bones, the detail sits on separate pages. Use the links below to go to the page that matches your injury.
Fractures we treat
- Distal radius (wrist) fractures
A break at the end of the radius, just above the wrist. The most common fracture of the upper limb. - Hand fractures: metacarpal and phalangeal
Breaks in the long bones of the palm and in the finger and thumb bones. - Scaphoid fractures and non-union
A break in a small wrist bone that is easily missed and, if untreated, may fail to heal.
If you are not sure which applies to you, start with the page closest to where your pain is, or contact us.
At a glance
What is it?
A break in one of the 27 bones of the hand and wrist
Common symptoms
Pain, swelling, bruising, loss of movement, and sometimes a visible change in shape or finger alignment
Who it affects
Anyone. Falls, sport and workplace injuries are the usual causes
Is it serious?
Most heal well. Some fractures affect long-term hand function if the position is not corrected, or if healing fails
Treatment options
Most hand and wrist fractures do not need an operation. Splinting or casting, hand therapy, or surgery when the position or stability requires it
First step
Early assessment. In Victoria this can be done by telehealth through the Melbourne Hand Surgery's Online Fracture Assessment
Symptoms and how it presents
Most fractures cause pain, swelling and bruising that begin soon after the injury, and pain that is worse when the bone is loaded or the joint is moved.
Findings that point to a fracture needing prompt assessment include:
- A finger that crosses over or under its neighbour when you make a fist
- A visible bend, step or rotation in a finger
- Inability to straighten or bend a finger fully
- Deep tenderness in the hollow at the base of the thumb, which can indicate a scaphoid fracture
- Numbness or pins and needles in the hand
- A wound over the fracture site
A scaphoid fracture deserves particular mention. It often causes surprisingly little swelling, is frequently mistaken for a sprain, and may not show on an initial X-ray. Wrist pain after a fall that has not settled within a week should be reassessed.
Causes and risk factors
- A fall onto an outstretched hand, the usual cause of distal radius and scaphoid fractures
- Sport, particularly ball sports, contact sports and cycling
- A direct blow or crush, including workplace and machinery injuries
- Reduced bone density, which makes fractures more likely from a lower-energy fall
If you have broken a bone after a fall from standing height, it is worth discussing bone health with your GP.
How is it diagnosed?
Assessment combines the history of the injury, examination of the hand, and imaging.
X-rays are the first-line investigation and are usually enough. CT is sometimes used where the fracture enters a joint or the fragments are difficult to see. MRI or CT may be used where a scaphoid fracture is suspected but not visible on the initial X-ray.
If you have already had imaging elsewhere, bring the images or the access details with you. See radiology provider access for how we obtain images from your imaging provider.
Treatment options
Most hand and wrist fractures do not need an operation.
- Splinting or casting. A well-positioned, stable fracture is protected while it heals, with review to confirm the position is maintained.
- Buddy strapping and early movement. Used for some finger fractures, where moving the finger early prevents stiffness.
- Hand therapy. Guided movement, swelling management and splinting, both instead of and after surgery.
- Surgery. Considered where the fragments are out of position, the fracture is unstable, the fracture enters a joint, or healing has failed.
The decision is not simply whether the bone is broken, but whether the position and stability will give you a hand that works. For what surgery involves, see fracture surgery.
The Melbourne Hand Surgery's Online Fracture Assessment
Melbourne Hand Surgery runs the Melbourne Hand Surgery’s Online Fracture Assessment, a rapid-access telehealth clinic for people anywhere in Victoria with a recent hand fracture.
Your fracture and your images are reviewed by a hand surgeon in a video consultation, and you are given a clear opinion on what your fracture needs. If hand therapy is required, referral to an accredited hand therapist is arranged.
This service is of particular benefit to regional and rural patients. Access to a hand surgeon can be difficult outside metropolitan Melbourne, and the distance to travel is significant at the best of times. It is worse when your hand is fractured, painful, swollen and splinted, and when you may not be able to drive yourself. The virtual clinic removes that trip for the assessment, so the decision about your fracture is made early rather than after a long wait or a long drive.
- 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 fractures or contact us directly.
- Cost: this is a private clinic. Payment is required for your appointment. See fees and informed financial consent.
When to see a hand surgeon
Seek assessment promptly if any of the following apply:
- A finger that is visibly bent, rotated, or crosses its neighbour when you make a fist
- Wrist pain after a fall that has not settled within a week, even if an X-ray was reported as normal
- Numbness or pins and needles in the hand after the injury
- A wound over the fracture site
- A fracture you have been told is displaced or unstable
- Increasing pain or swelling in a splint or cast
Timing matters more with fractures than with most hand conditions. If you need to be seen quickly, see getting an earlier or emergency appointment. If you are in Victoria and outside metropolitan Melbourne, the Melbourne Hand Surgery’s Online Fracture Assessment may be the faster route.
What to expect at your appointment
Bring your referral, your imaging or the details needed to access it, a list of your medications, and the date the injury happened. If you are already in a splint or cast, wear it in rather than removing it beforehand.
Dr Tomlinson will review your images, examine the hand, and explain what has been broken, whether the position is acceptable, and what the options are. If an operation is recommended, the reasons, the alternatives, the recovery and the fees are discussed at that visit.
See also preparing for your appointment.
Frequently asked questions
Will my fracture need surgery?
Probably not. Most hand and wrist fractures are treated without an operation.
Surgery is considered when the fragments are out of position in a way that would affect how the hand works, when the fracture is unstable and likely to move, when the break runs into a joint surface, or when a fracture has failed to heal. Which of those applies can only be judged from your images and your examination.
How long does a hand or wrist fracture take to heal?
Bone healing and recovery of hand function are two different timelines. The bone usually unites well before the hand feels normal, although in some instances the bone may be weak (not healed) when you feel that your hand is strong – and this increases the risk that the fracture will not heal, as you may repetitively load the fracture more than it can tolerate. Stiffness, swelling and reduced grip strength may persist for some months after the fracture itself has healed.
My X-ray was normal but my wrist still hurts. What now?
A normal X-ray does not always exclude a fracture, and the scaphoid is the classic example. A scaphoid fracture can be invisible on the first X-ray and only become apparent later.
If you have wrist pain after a fall that has not settled within a week, particularly tenderness in the hollow at the base of the thumb, it should be reassessed. Further imaging may be needed. See scaphoid fractures and non-union.
I live in regional Victoria. Do I have to travel to Melbourne?
Not necessarily for the assessment. The Melbourne Hand Surgery’s Online Fracture Assessment exists precisely for this. It lets a hand surgeon review your fracture and your images by video consultation from wherever you are in Victoria.
If your fracture turns out to need an operation, that does require travel. But many do not, and finding that out does not need to cost you a day and several hundred kilometres with a broken hand.
How does the Melbourne Hand Surgery's Online Fracture Assessment work?
It is a rapid-access virtual assessment clinic. You register, your imaging is obtained, and you have a video consultation in which a hand surgeon reviews your fracture and gives you an opinion on what it needs. Referral to an accredited hand therapist is arranged if required.
Full details, including how to register and how to check in for your appointment, are on the service page. It is a private clinic and payment is required for your appointment.
Does the virtual service cover wrist fractures?
No. The virtual service covers fractures of the hand: the fingers, thumb, metacarpals and carpal bones including the scaphoid. Distal radius fractures, which are breaks of the forearm bone at the wrist, are not covered.
If you have a distal radius fracture, see distal radius (wrist) fractures or contact us to arrange an appointment.
Can children use the virtual fracture service?
Yes, from age 10. The service is for adults and children aged 10 and over with a recent hand fracture. A parent or guardian should be present for the consultation.
For younger children, please contact us to discuss the most appropriate arrangement.
Does Melbourne Hand Surgery accept WorkCover or TAC patients?
WorkCover and TAC is accepted case by case depending on capacity. Melbourne Hand Surgery is a private clinic that charges a private fee and does not bill WorkCover and TAC directly. This means that individuals who are insured by WorkCover and TAC will have out of pocket costs for their consultation and surgery.
Will I need hand therapy?
Yes. Hand therapy is a central part of fracture care, whether or not you have an operation. A hand that has been immobilised stiffens, and guided movement is how that is prevented and reversed.
Dr Tomlinson will arrange a referral to a hand therapist – a physiotherapist or occupational therapist with additional training in the hand – where it is needed.
How soon do I need to be seen?
Sooner than for most hand conditions. The decisions that most affect long-term function are ideally made in the first week or two, while the fracture can still be repositioned relatively easily.