What kind of finger fractures are there?
The fracture can pass through the body of the phalanx, its base or head, and also affect the joint. Separately, avulsion fractures are distinguished when a tendon tears out a fragment of bone: a typical example is a finger that ceases to extend at the end joint after being hit by a ball. Fractures of the base of the thumb require special attention because it affects grip. In children, the fracture line often passes through the growth plate, and such injuries need precise reduction to prevent the finger from growing crookedly.
- Fracture of the phalanx body - transverse, oblique, helical
- Intra-articular fractures of the base and head
- Avulsion fractures with tendon damage
- Comminuted fractures of the terminal phalanx due to pinching
- Growth plate fractures in children
- Open fractures with damage to the skin and nail bed
Symptoms and first aid
Immediately after the injury, the finger hurts sharply, quickly swells and turns blue, and movements are limited. When displaced, deformation, shortening or rotation of the finger is noticeable - this is especially visible when trying to bend all the fingers towards the palm: the broken one deviates to the side. When struck, blood accumulates under the nail, which causes severe bursting pain. Before being examined by a doctor, the finger is fixed to the adjacent one with a soft bandage, the rings are removed, cold is applied through the fabric and the hand is kept elevated. You cannot reset your finger yourself.
- Sharp pain and rapid swelling
- Bruising, hematoma under the nail
- Deformation, shortening, reversal of the finger
- Limitation of flexion and extension
- First aid: remove rings, cold, fixation to adjacent finger, elevated position
Diagnostics
The main method is an x-ray of the hand or individual finger in at least two projections, and if an intra-articular fracture is suspected, an oblique one is added. The image shows the fracture line, displacement and involvement of the joint. CT is used for multi-fragmented and intra-articular injuries, when it is necessary to accurately plan the operation. Ultrasound helps assess the integrity of the tendons if the finger does not straighten due to an apparently small fracture. Be sure to check active movements: the inability to straighten the terminal phalanx indicates damage to the extensor.
- X-ray of the finger and hand in two or three projections
- CT scan for intra-articular or comminuted fracture
- Ultrasound of tendons and soft tissues
- Checking active movements and sensitivity
- Examination of the nail bed for subungual hematoma
Treatment
Non-displaced fractures are treated with fixation: aluminum splints, a plaster or polymer bandage are used, sometimes it is enough to bandage the damaged finger to the adjacent one. The fixation period is usually 3–4 weeks, while efforts are made not to immobilize adjacent joints. If there is displacement, the doctor performs a closed reduction under local anesthesia, and if the fragments are unstable, he fixes them with knitting needles, screws or a mini-plate. The doctor evacuates a large, intense hematoma under the nail through a puncture - this quickly relieves the pain. Open fractures require debridement and antibiotics.
- Splint or fixation to an adjacent finger for 3–4 weeks
- Closed reduction with displacement
- Osteosynthesis with knitting needles, screws, mini-plate
- Drainage of subungual hematoma
- Wound treatment and antibiotics for open fractures
- Control photo after 7–10 days
Movement restoration
The hand does not tolerate prolonged immobility well: even a few extra weeks in a splint lead to stiffness, which is then difficult to develop. Therefore, exercises for free joints begin immediately, and after the fixation is removed, active development of the damaged finger is involved - flexion, extension, work with a soft ball and plasticine. Swelling and morning stiffness may persist for several months; this is normal. Full grip strength usually returns within 2–3 months. If, a few weeks after removing the splint, the finger almost does not bend, a re-examination and sessions with a rehabilitator are needed.
- Movements in free joints from the first days
- Active development after uncommitting
- Grasping and fine motor exercises
- Elevated hand position against swelling
- Return to exercise and sports with doctor's permission
- Repeated examination for persistent limitation of movements