The fingers are made up of three bones: the distal phalanx (the smallest bone closest to the finger tip), the middle phalanx (the next bone, located between the two small joints of the finger) and the proximal phalanx (the bone closest to the large knuckle that joins your finger to your hand). Fractures of these finger bones are very common.
Fractures of the distal phalanx commonly occur due to impaction: they are commonly caught in doors, hit by balls or crushed when the finger gets caught beneath a heavy object. Fractures just beneath the fingertip may often be treated in a splint for 4 weeks. However, up to 1/3 of these fractures may lead to tenderness and pain when cold for 1-2 years. Some fractures of the distal phalanx are similar to ‘bony mallet injuries’ (see my previous blog on mallet injuries). If the joint is not subluxed (ie. if the bones are still lined up correctly) then these fractures are treated similar to mallet injuries, with 6 weeks of full-time splinting followed by 6 weeks of part-time splinting. If the joint is subluxed, then these fractures usually do better when treated early by surgery. Occasionally, larger fractures of the distal phalanx are displaced (in poor position) and require operative fixation.
One of the biggest problem with finger fractures is that they heal very quickly, often within 3 weeks. If the patient doesn’t present to the hand surgeon quickly, then by 3 weeks the fracture is often healed in an unacceptable position, which can permanently compromise hand function. People often think “it’s just a sprain”, or “if it was broken then I couldn’t move it”, or “if it was broken then I’d see a big deformity (or more swelling, more bruising, etc). Unfortunately, all of these beliefs are often false. Many times, only an X-ray can tell for sure whether a finger is fractured or not. And once the finger has healed in a bad position it’s much tougher (for both the surgeon and the patient) to correct it compared to if it had been treated early so that it healed in good position.
Fractures of the middle and proximal phalanges are troublesome injuries. If there is significant angulation or displacement, then surgical fixation will be required in order to allow the bone to heal in a ‘straight’ position. If treated early, many of these fractures can be manipulated into position and pins (or occasionally screws) placed ‘closed’, without an incision, which decreases the amount of post-surgical scar formation. If the fracture is seen later, an open incision is usually required. Some fractures do better with plate or screw fixation performed through an open incision, regardless of when they are seen. However, these are still easier to predictably fix in optimal position when seen earlier, as opposed to being seen later.
The main problem with finger fractures is that the bones are right next to the flexor tendons and extensor tendons that move the fingers. The broken bones scar to these adjacent tendons, leading to stiffness of the finger joints. This is often unavoidable, and this tendency to scar can often only be minimized, not completely eliminated. Plates and screws may provide more rigid fixation for many fracture that allows early therapy and early motion to begin so that stiffness is minimized. It depends on the fracture. However, despite excellent treatment some patients will still scar and require a second surgery to release that scar. Much is related to the individual’s individual biology, ie. their tendency to scar.
For the best results from finger injuries see a hand surgeon (ie. a sub-specialist) quickly. Even, if no bones are broken, a hand specialist can treat the injury to return you to activity the quickest. If the bone is broken, then the best way to ensure the best outcome is to get expert treatment at an early time.
