Hand Fracture Fixation

Your Procedure

You have had an operation to provide fixation of fractures in your hand. This is an operation that can be performed through punctures or small incisions in your hand and can use smooth pins, plates, screws, or a combination of these methods. Fixation is usually supplemented with a splint or cast to support the repair.

What to Expect

Have nothing to eat or drink after midnight on the night before surgery. Take your usual medications on the morning of your surgery with a small sip of water. You will likely be able to go home a couple of hours after your operation and need to ensure that you have a responsible adult to take you home and stay with you that night. Some discomfort is normal after surgery. You can also expect to have limitations in your activities due to intentional immobilization in surgical splints.

Surgical Site Care

Please keep your splint in place, clean and dry, until your follow-up appointment, unless explicitly instructed otherwise. You may loosen the tensor bandage if it feels too tight.
Depending on your exact fracture pattern, and your operation, your surgeon may ask you to keep your splint on all the time or take your splint on and off to move your hand. Whether your surgeon ultimately asks you to keep your splint on at all times or remove it to exercise your hand, it is important to remember that the pins or screws placed in your hand are very small and will not be able to hold a full load until your bone is healed. You will therefore need to have protection for your hand and can expect limited use of your operated hand for at least four weeks.

Activity and Care at Home

Keep your hand and arm elevated (higher than the heart) for the first few days to limit swelling. You can apply ice or a cold compress over your surgical site, if you wish. Do not leave ice on for more than 10 minutes at a time. It is very important to move all of your fingers that have been left out of your bandage or cast to prevent stiffness.
If you have had hand surgery under a general anaesthetic or sedation you must not drive or operate other machinery for 24 hours after surgery. Please note that the Motor Vehicle Act of BC 195 (1) prohibits operation of a motor vehicle if "the control of the driver over the driving mechanism of the vehicle... is obstructed." Driving with a hand injury or cast in place that impairs your ability to hold the steering wheel is therefore in violation of the Act. You may resume driving once you have return of function to your operated hand and no longer require narcotic pain medication.

Medications and Pain Management

Some discomfort and pain following surgery is to be expected. Staying ahead of your pain for the first 48 hours helps. Non-opioid medications should be prioritized and opioids only taken if extra pain control is required. Try to take as few opioids as possible (codeine, tramadol, dilaudid, morphine, oxycodone).
Try taking two extra strength acetaminophen/ Tylenol (500mg) every six hours or two regular strength acetaminophen/ Tylenol (325mg) every four hours. Be aware that some prescribed medications already have acetaminophen in them (usually 325mg), so substitute each one of regular strength acetaminophen tablets every 4 hours with a prescription medication if you need, so that you do not take more than 4000 mg of acetaminophen in 24 hours. You can also add ibuprofen/ Advil (400mg) three times per day. Patients with liver disease should be careful with the acetaminophen dose and those with asthma or renal disease should be careful with anti-inflammatories like ibuprofen.

What to watch for / when to call / who to call

If you experience increasing rather than decreasing pain, worsening numbness, swelling, foul odor, or redness in the hand, excessive bleeding that is not controlled with pressure, fever, chills, shortness of breath, or arm or leg pain, please call your surgeon's office.
Local anesthetic used during the operation (in addition to general anesthesia) will cause fingers to be numb after surgery for many hours.

Follow-up

Your first follow-up appointment will be planned 1-2 weeks from surgery. You can expect to have your surgical sites checked and your splint changed. Depending on your initial injury and operation, you may be allowed out of your new splint a few times per day to perform exercises or you may need continuous immobilization for a further few weeks.
You may have a referral to hand therapy. If you do, contact them as soon as possible.