Effectiveness of clinical estimation of bone union in hand fractures: a preliminary report

Andrzej Żyluk


An assessment of the healing of bone fractures is mainly based on X-ray confirmation of some characteristic features of fracture consolidation. This paper presents a new method of estimation of bone union of hand fractures based on examination of pain resulting from pressure of the fracture site. It was assumed that bone is united if at 2–3 weeks the fracture site is painless. The pain at the fracture site was examined in 12 patients with fractures of phalanges and metacarpals of specified configuration; an assessment was performed at the beginning of the treatment and after 2, 3, and finally at 4 weeks. All patients were treated by functional method, without any immobilization. At baseline, the mean level of pain in numeric rating scale was 6.4 and in subsequent assessments a significant reduction in pain
was observed, down to 0.6 at 4 weeks. Radiological assessment at 4 weeks showed a lack of consolidation of the fracture in 8 patients and at 8 weeks in 4. Despite this, all patients demonstrated normal function of the hand and all returned to normal daily activity and to work. The results of this study demonstrate that clinical assessment of phalangeal or metacarpal fracture healing based on the lack of pain in reaction to applying pressure on the fracture site is a better and more reliable method than radiological estimation which shows bone union significantly later. The proposed clinical assessment allows patients a significantly earlier normal use of the affected hand.


phalangeal fracture; metacarpal fracture; functional treatment; outcome assessment

Full Text:



Feehan LM, Sheps SS. Treating hand fractures: population-based study of acute health care use in British Columbia. Can Fam Physician 2008;54(7):1001-7.

Held M, Jordaan P, Laubscher M, Singer M, Solomons M. Conservative treatment of fractures of the proximal phalanx: an option even for unstable fracture patterns. Hand Surg 2013;18(2):229-34.

Lalonde D, Ayhan E, Ahmad AA, Koehler S. Important updates of finger fractures, entrapment neuropathies and wide-awake surgery of the upper extremity. J Hand Surg Eur Vol 2022;47(1):24-30.

Lalonde D. Preferred methods which are against traditional teachings. J Hand Surg Eur Vol 2021;46(3):327-30.

Giddins GE. The non-operative management of hand fractures. J Hand Surg Eur Vol 2015;40(1):33-41.

Khan A, Giddins G. The outcome of conservative treatment of spiral metacarpal fractures and the role of the deep transverse metacarpal ligaments in stabilizing these injuries. J Hand Surg Eur Vol 2015;40(1):59-62.

Żyluk A. Outomes of the treating hand fractures without using immobilization. Pomeranian J Life Sci 2022;68(3):1-4. doi: 10.21164/pomjlifesci.825.

DOI: https://doi.org/10.21164/pomjlifesci.855

Copyright (c) 2023 Andrzej Żyluk

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/