I am a professional card dealer in a large Las Vegas casino. Unfortunately, I fell on the ice and broke my hand. I’ve had surgery to pin two bones together and I’m in a cast. What can I expect for recovery (how long will it take? will I get full use of my hand again)?

Whether from sports-related activities, work injuries, car accidents, or falls, hand fractures can cause significant pain and disability. But most patients can expect that, in time, they can return to normal motion and use of the involved hand.

An accurate and timely diagnosis is always the first step. With careful review of the patient’s history (including the mechanism of injury), physical examination, and good quality X-rays, most hand fractures can be identified and a plan of care developed. It sounds like you are well past this phase. The main stumbling block in this process is making sure that all other injuries (especially soft tissue damage of nerves, tendons, and ligaments) are recognized and adequately treated.

Special attention must be paid to intraarticular fractures (fractures that extend into the joint). This type of fracture is often accompanied by damage/rupture of the ligaments needed for joint stability.

Fortunately, the hand is versatile, resilient, and forgiving making it possible to treat hand fractures without surgery. Conservative (nonoperative) care consisting of short-term immobilization in a splint or cast is acceptable for many people. In some cases, a particular position of the hand and wrist is necessary to limit specific motions.

But in selected cases, surgery will aid and assist healing and recovery. And this is evidently where you find yourself. Complications are to be expected with stiffness being the most common (and most difficult to treat) problem encountered. Infection around pins, screws, and wires used to hold the bones together during healing is another potential problem. The choice of hardware and the amount of skin tension on the wires are risk factors for infection that can be managed by the surgeon.

Postoperative care is just as important as the surgery itself. Ask your surgeon for a referral to a hand therapist (usually a physical or occupational therapist). The therapist will tailor your rehab program to meet the specific needs for the type of job you have. The surgeon and the therapist will be the best ones to advise you as to expectations (how long will it take and expected recovery).