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

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.