Bones in the hand and wrist

Anatomy: Bones of the hand and wrist

The bony unit of the hand and wrist includes the distal ends of the radius (radius) and ulna (ulna), the eight carpal bones (scaphoid/scaphoid, lunate/lunate, triangular bone/triquetrum, peabone/pisiform, trapezium, trapezoid, head bone/capitatum, hookbone/hamatum), the five metacarpal bones (metacarpals I–V) and the finger bones (phalanges).

• Wrist: Joint between the radius/ulna and the carpus – high demands on stability and mobility.
• Scaphoid: Often affected by fractures; the blood supply to the proximal pole is delicate.
• Metacarpalia: Carrying grip strength; Shaft and base fractures are common in sports.
• Phalanges: basal, middle and distal phalanges; small shifts can affect the finger axis.

The bones are functionally connected via strong ligaments, tendons and muscles. A special feature of the hand is that even minor changes in shape (e.g. after fractures) can lead to relevant limitations in fine motor skills and strength.

Typical complaints and warning signs

• Pain and tenderness locally (e.g. in the “snuff pit” in the event of a scaphoid injury)
• Swelling, bruising, overheating
• Restriction of movement, loss of strength, unsteady grip
• Misalignment or “step formation” on the bone
• Grinding/grinding (crepitus) when moving
• Numbness/tingling (indication of nerve involvement)
• Fever, chills, redness if infection is suspected (osteomyelitis)

In the case of open injuries, significant misalignments, severe pain at rest, persistent hand swelling after a fall or increasing symptoms despite rest, medical attention should be sought promptly.

Causes and risk factors

• Falling onto the hand (most common cause of distal radius and scaphoid fractures)
• Direct force (blow, crush) – often metacarpal/finger fractures
• Repeated microtraumas (overload, stress reactions)
• Pre-existing bone weakness (e.g. osteoporosis, vitamin D deficiency)
• Smoking – increases risk of delayed bone healing/nonunion
• Metabolic and vascular diseases, diabetes, immunosuppression – increased risk of infection
• Bite injuries or open wounds – possible entry points for germs (osteomyelitis)

Diagnostics: structured and gentle

A reliable diagnosis is the basis of every treatment. We combine a targeted clinical examination with modern imaging and always check whether conservative measures are sufficient.

Important: If there is a clinical suspicion of a scaphoid fracture despite an unremarkable X-ray, the patient is often initially immobilized and verified with an early MRI or delayed follow-up X-ray.

Therapy principles: conservative first, targeted surgery if necessary

The aim of the treatment is to reduce pain, bone stability and the best possible restoration of hand function. We prioritize conservative options where stability and axle ratios allow.

Conservative measures

• Immobilization: Splint/orthosis or plaster – adapted to the fracture type and healing process.
• Elevation, cooling (acute) and anti-inflammatory measures.
• Pain management as needed (taking into account individual risks).
• Early function of adjacent joints to avoid stiffness - in coordination with immobilization.
• Hand therapy/occupational therapy to restore mobility, strength and coordination.
• Risk modification: quitting smoking, adequate protein/calcium/vitamin D intake, treatment of osteoporosis.

Surgical indications (selection)

• Unstable or significantly displaced fractures, especially fractures involving joints
• Multi-fragment fractures with risk of malunion
• Lack of bone healing (pseudarthrosis), esp. a. on the scaphoid
• Symptomatic misalignments with loss of function
• Infections of the bone requiring surgical repair

Depending on the fracture type, best practices include: B. Screw osteosynthesis (scaphoid), angle-stable plate osteosynthesis (distal radius), wire/screw fixation (metacarpals/fingers) or corrective osteotomy for malunion. In the case of osteomyelitis, the focus is on cleaning the infected tissue and targeted antibiotic therapy. The decision is made individually and after detailed information.

Important clinical pictures at a glance

• Scaphoid fracture (broken scaphoid bone): Common after a fall; localized pain in the snuff pit. Conservative immobilization or screwing – see below.
• Distal radius fracture (broken radius): Very common; Therapy spectrum from splint to angle-stable plate – see below.
• Distal ulnar fracture (ulnar): Often combined with radius injury; Pay attention to the stability of the DRUG (distal spoke-ulna joint) – see underside.
• Metacarpal fractures (metacarpal): impact/sports injuries; Avoid axis and rotation errors – see below.
• Finger fractures (phalanges): Small deviations with a big effect; Individual rail concepts – see below.
• Scaphoid pseudoarthrosis: Failure to heal the scaphoid; Special procedure including bone building – see below.
• Misalignments after fractures: If function suffers, correction may make sense - see below.
• Osteomyelitis of the hand: bone infection following injury/surgery or hematogenous; requires targeted diagnostics and therapy – see below.

Circulatory disorders of individual carpal bones (e.g. lunate necrosis, Kienböck's disease) are explained under the focus of blood circulation, as vascular factors are in the foreground.

Prevention and aftercare

• Fall prevention: Non-slip footwear, balance and reaction training - important in winter conditions.
• Sports techniques and protection: wrist guards for high-risk sports; correct bat/ball technique.
• Bone health: Sufficient vitamin D/calcium through diet; If you have a risk profile, consider osteoporosis screening.
• Workplace ergonomics: carry loads close to the body, reduce repetitive impact loads.
• Avoiding smoking: Supports bone healing.
• Follow-up care: Medical checks, if necessary follow-up via X-ray/CT/MRI; consistent hand therapy, scar and edema management.

When to go to the practice and when to the emergency room?

• Immediately go to the emergency room: open fracture, significant misalignment, severe circulatory/sensory disorders, visible bone parts, high fever if infection is suspected.
• Immediate practical presentation: Persistent pain/swelling after a fall, local tenderness over the scaphoid, limited function, suspected stress injury or delayed healing.
• Control/Course: After immobilization to check the position and healing; Present earlier if symptoms increase.

Your contact point in Hamburg-Winterhude

In our orthopedic practice at Dorotheenstrasse 48, 22301 Hamburg, you will receive a structured assessment of bone problems in the hand and wrist. We work in a guideline-oriented, conservatively focused manner and, if necessary, involve hand surgical partners in Hamburg. Appointments can be made easily via Doctolib or by email.