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Date issued: February 2024

Review date: February 2026 

Ref: C-409/JT/OT/Thumb Fractures and soft tissue injury advice v4

PDF:  Thumb fracture and soft tissue injury advice final February 2024 v4.pdf[pdf] 501KB

Thumb Metacarpal / Bennett / Rolando Fracture

The metacarpal is the long bone in your hand / thumb.    

A fracture is the term used for a broken bone.

Common Symptoms

• Pain

• Swelling

• Bruising

• Reduced movement

• Lump over fracture site

Thumb Proximal Phalanx Fracture

The proximal phalanx is the bone which attaches your thumb to your hand.

Thumb Distal Phalanx Fracture

The distal phalanx is the small bone at the tip of your thumb.

How to manage a fracture?

In most cases this is treated conservatively (no surgery) by cast/splint for a total of 4-6 weeks. This provides protection to the healing bone but will also allow movement of unaffected digits/joints.

Please wear your cast/splint (delete as appropriate):

• As directed by your therapist……………………………

• When advised by your therapist remove splint daily to wash hand in sink / bowl.

• Wear splint in shower / bath

Can I do daily activities?

Use your hand for light activities only whilst it is supported (up to the weight of a cup of tea). After 4 weeks, gradually resume your day-to-day activities.

The bone will not be strong enough for heavy work or non-contact sports until at least six weeks.

Contact sports, in particular boxing, should be avoided until at least 12 weeks after injury.

Thumb Soft Tissue / Collateral Ligament Injury

The collateral ligaments are located at either side of the joint where your thumb attaches to your hand providing stability to the joint.

It is injured when the thumb is caught against another object and is pulled away from the hand. The ligaments can either be strained, torn, or a chunk of bone can be pulled off which is called an avulsion fracture.

How to manage a collateral ligament injury?

In most cases this is treated conservatively by cast/splint for a total of 6 weeks. This provides protection to the healing soft tissue/bone but will also allow movement of unaffected digits/joints.

Please wear your cast/splint (delete as appropriate):

• As directed by your therapist……………………………

• When advised by your therapist remove splint daily to wash hand in sink / bowl.

• Wear splint in shower / bath

Thermoplastic Splint (TP splint).

Your splint has been made from:

Please wear your cast/splint:

How to care for your splint:

Wash splint regularly using lukewarm water and small nailbrush.  Rinse well.

Always keep splint away from direct heat source i.e. radiators, fires, tumble dryers, hot water bottles and sunlight through glass

Your splint will lose shape and become sticky at temperatures of 65 degrees and over.

Never attempt to re-shape or alter the splint yourself.

If you are concerned about your splint, seek advice from your therapist.

Surgical Management

Open Reduction Internal Fixation (ORIF)

This involves using screws with or without a metal plate to permanently support the fracture site so it can heal in a good position. Unless there is a problem with the skin or metalwork, the metalwork is not removed and remains long-term. You will have a wound/scar where they have opened the skin for the operation. You will wear a cast/splint for a total of 4-6 weeks.

Wound care

It is important to keep your wound clean and dry whilst you have stitches in. Once the sutures are removed and the wound is healed start scar massage. Using unperfumed moisturiser massage the scar using firm circular movements 3-4 times per day for at least 5 mins. This will flatten the scars appearance, prevent sticking / adhesions, reduce sensitivity and avoid any tightness.

K- Wire Fixations

K wires are a short-term fixation involving metal wires that hold a fracture in place. These wires are inserted through the skin into the bone. The wires are usually left in place for 4 weeks and then removed in an outpatient clinic. The wires are removed using a set of forceps, the wire is pulled out and is usually pain free. You will wear a cast/splint for a total of 4-6 weeks.

Pin Site Care

It is important to keep the skin around the k wires clean and dry.

Initially you will have a bandage/cast around the hand. When you return for a cast change, your pin sites will be cleaned, and you will be shown how to care for them. You will be provided with sterile water, gauze, and dressings.

Once a week:

Remove splint and old dressing.

Remove x2 gauze from packet.

Poor sterile water onto remaining x3 gauze in packet.

Clean each individual pin site with a clean gauze.

Dry pin site with dry gauze.

Re-dress and re-apply splint.

Important:

If you notice any increased redness, pain, discharge from the pin site please contact the clinic ASAP Tel. 01752 432105

Swelling

Swelling is normal and can take months to resolve. Try to keep your hand elevated. When sitting down, put some pillows on the arm of the chair to rest your hand above the level of your heart and use a sling when you are walking around.

Once any wounds are healed and the splint/support/strapping can be removed contrast bathing is an excellent way to ease the swelling, stiffness, and pain in your hand.

Fill one bowl with water hot enough to comfortably tolerate and another with cold water and ice cubes/unopened bag of frozen peas. Immerse your hand in each bowl for 30 seconds at a time starting in the hot water, repeat 7 times ending in the hot water. You can repeat this regularly throughout the day to help with pain and swelling.

Can I do daily activities?

Use your hand / thumb for light activities only whilst it is supported (up to the weight of a cup of tea). After 6 weeks, gradually resume your day-to-day activities.

Your thumb will not be strong enough for heavy work or non-contact sports until at least eight weeks post injury.

Contact sports, in particular boxing, should be avoided until at least 12 weeks after injury.

Exercise

It is normal for your joints to feel stiff and uncomfortable after an injury, but this will ease by doing regular exercises.

The below exercises are specific exercises which promote the motion of tendons in the surrounding soft tissues. These exercises also help to reduce swelling in your hand.

Your therapist will advise you which specific exercises to do that are safe for your condition/injury and when to start them.

The following exercises are to be performed:…..….times a day.

Each movement is to be performed for:……repetitions.

Holding each position for:………..…seconds.

Exercise 1

Top joint of your thumb

• Use your other hand to hold your thumb just below the top joint

• Bend down the top joint of your thumb.

• Straighten your thumb.

Exercise 2

Knuckle joint of your thumb

Exercise 2

Bottom joint of thumb

• Use your other hand to hold just below the knuckle joint of your thumb.

• Bend down the knuckle joint of your thumb.

• Straighten your thumb.

Thumb flexion exercise at basal joint

Exercise 3

Basal joint of your thumb

• Rest the back of your hand on a table.

• Raise your thumb above your index finger.

• Move your thumb across the palm.

• Move your thumb back to the starting position.

Exercise 4

Thumb extension

• Rest the back of your hand on the table or place your palm on the table.

• Move your thumb next to your index finger.

• Straighten your thumb.

Exercise 5

Thumb opposition exercises

• Move your thumb to touch the tip of your index finger, aiming to make a good “O” shape with the tip of your thumb and finger.

• Repeat the same movement with your thumb and other fingers.

• Proceed to touching the little finger if pain free.

Thumb flexion exercises

Exercise 6

Flexion exercise

• Move the thumb across the palm to touch the tip of ring or little finger if possible.

• Gradually slide and bend your thumb down the finger to the palm

Exercise 7

Thumb circumduction

• Gently move your thumb in circular motion, both clockwise and anti-clockwise.