Should a thumb fracture of the dominant hand be referred to an orthopedic doctor or a hand doctor (hand surgeon)?

From the Guidelines

A thumb fracture of the dominant hand should ideally be referred to a hand surgeon. Hand surgeons are specialists who have completed additional training specifically focused on the complex anatomy of the hand, wrist, and forearm, making them particularly qualified to treat thumb fractures. While orthopedic surgeons can certainly manage thumb fractures, hand surgeons typically have more specialized experience with the intricate structures of the hand, including the thumb's unique saddle joint that enables opposition (the ability to touch the thumb to other fingers) 1. This joint is crucial for grip strength and fine motor skills, which are especially important in the dominant hand.

The treatment for a thumb fracture varies depending on the location and severity of the fracture, potentially including casting, splinting, or surgery with pins, screws, or plates. Given the thumb's importance in daily activities and the potential for long-term functional impairment if not properly treated, seeking care from a specialist with the highest level of training in hand injuries is recommended to ensure optimal outcomes and preservation of function in your dominant hand. According to the American College of Radiology, radiographs are usually sufficient for the evaluation of osseous injuries, including thumb fractures, and can help guide treatment decisions 1.

Some key points to consider when treating thumb fractures include:

• The importance of early and accurate diagnosis to prevent long-term complications
• The need for specialized care from a hand surgeon to ensure optimal outcomes
• The potential for various treatment options, including casting, splinting, or surgery, depending on the location and severity of the fracture
• The importance of preserving function in the dominant hand to maintain daily activities and quality of life. Although the provided evidence primarily discusses distal radius fractures 1, the principles of seeking specialized care for complex hand injuries can be applied to thumb fractures as well.

From the Research

Referral for Thumb Fracture of Dominant Hand

When it comes to a thumb fracture of the dominant hand, the decision to refer to an orthopedic doctor or a hand doctor (hand surgeon) depends on several factors.

• The complexity and stability of the fracture play a significant role in determining the need for specialized care 2, 3.
• If the fracture is unstable or has rotation, it is recommended that an orthopedic or hand surgeon should treat it 2.
• For thumb fractures that are stable and do not require surgical intervention, family physicians or general practitioners can provide initial treatment and management 2.
• However, given the importance of the thumb in overall hand function, accounting for up to 50% of hand use 4, and the potential for complications or the need for precise management to maximize future function, referral to a specialist may often be prudent.

Considerations for Referral

Considerations for referral include:

• The severity of the fracture and whether it is open or very complex, which may necessitate more specialized care 5.
• The patient's hand dominance, as fractures in the dominant hand may require more precise management to ensure optimal recovery and function 3.
• The presence of any concomitant soft tissue injuries or other complications that may require the expertise of an orthopedic or hand surgeon 2, 6.

Specialist Care

Specialist care from an orthopedic doctor or a hand surgeon is particularly important for:

• Unstable fractures or those with significant displacement or rotation 2.
• Fractures that require surgical intervention, including open reduction and internal fixation, or other operative methods 5, 6.
• Cases where there is a high risk of complications or where precise management is critical to prevent long-term disability or morbidity 3.