Adult Finger Fractures
A Patient’s Guide to Adult Finger Fractures
Signs and Symptoms
Because we use our hands to manipulate our world, fingers commonly get in harm’s way. A finger fracture can occur in a multitude of ways, but many injuries occur due to crushing or wrenching the finger away from the palm. There is usually immediate pain and swelling in the finger. You may also see that the finger is deformed. It is common to see a bump over the back of the finger where the fracture is located and angulated (or bent). Many finger fractures also have lacerations or damage to the skin and soft tissues. Motion is painful; you will probably not be able to grip using the hand due to pain.
The primary goal of the clinical evaluation of a finger fracture is to determine the pattern of the fracture. Based on the fracture pattern, your surgeon will need to decide if 1) the fracture is in stable alignment and can be simply protected in special splint until it heals, 2) the fracture pattern can be reduced (or manipulated) to a stable alignment without surgery and held with a splint until it heals or 3) surgery will be necessary to align the fracture fragments and fix the fragments with some combination of metal pins, metal plates and metal screws. The fracture is evaluated by taking several x-rays of the hand and finger. Your surgeon will pay particular attention to fractures that involve the joints: the MCP, PIP and DIP joints. These fractures can both affect the stability of the joints and damage the joint surface, leading to weakness or continued pain after the fracture heals. These fractures commonly require surgery to repair the joint surface.
Many finger fractures do not require surgery. If the fracture involves one or more joints, surgery may be required to repair the joint. If the fracture is open (also called a âcompoundâ fracture), meaning there is a laceration that connects with the fracture, surgery is required to cleanse the fracture fragments and reduce the risk of infection.
Surgical treatment that ranges from relatively simple to more complex may be considered depending on the fracture pattern. Simple fracture patterns may be treated by placing metal pins through the skin and into the bone fragments to hold the fragments in position as they heal. These pins are inserted while you are in the operating room with the aid of a special X-ray machine called a fluoroscope. The fluoroscope allows the surgeon to see an X-ray image of the bones on a television monitor and guide the placement of the pins by viewing this image. This type of surgery may be done as an outpatient.
Stiffness is probably the most common complication of finger fractures. Stiffness can occur quickly even in the uninjured fingers if they are placed in a cast or splint. Your surgeon will want to get your fingers moving as soon as possible.
Nearly all fractures can result in damage to nerves and blood vessels; but this is a rare complication of most finger fractures – unless the injury has occurred due to crushing. The small nerves of the fingers can be damaged or cut as part of the crush injury. Completely severed nerves (and arteries) may need to be repaired surgically.
Because finger fractures are sometimes associated with punching someone, lacerations (cuts in the skin) can occur over the knuckles and joints as part of the injury. When these lacerations are caused by human teeth, there is a great risk of serious infection complicating the fracture. This will usually require immediate surgery to cleanse the wound, the knuckle joint and possibly the fracture to reduce the risk of serious infection.
The prognosis for finger fractures is variable depending on the severity of the injury. Because many finger fractures are crush injuries, it is not uncommon to have the fractures heal with some permanent stiffness in the fingers. Regaining full function may not be possible and it may take several months of rehabilitation with a hand therapist to reach your full potential. The fingers become stiff very fast after being immobilized – whether they are injured or not. Most hand surgeons try to limit the time that the fingers are immobilized and begin physical therapy as soon as possible to prevent stiffness from occurring.
Rehabilitation will begin once your surgeon feels that the fracture is stable enough to begin regaining the range of motion in your wrist, hand and fingers. If surgery has been required, the rehabilitation program will be modified to protect the fixation of the fracture fragments. Your surgeon will communicate with your physical therapist to make sure that your rehabilitation program does not risk causing the fixation to fail. If the surgeon feels that the fixation is very solid, you may be able progress your program quickly; if the fixation is not so solid, the speed at which you progress may need to be slowed until more healing occurs.