Fingers enable us to touch, grasp, and interact with our environment. Therefore, they are easily injured. Injuries may range from simple bruises or contusions to broken bones and dislocations of the joints.
Understanding the basic anatomy of the hand and fingers is very useful in understanding different types of finger injuries, broken fingers, and how some treatments differ from others.
The hand is divided into 3 sections: wrist, palm, and fingers. There are 8 bones in the wrist, which move together to allow the vast ranges of motion of the wrist. The palm or midhand is made up of the metacarpal bones. The metacarpal bones have muscular attachments and bridge the wrist to the individual fingers. These bones frequently are injured with direct trauma such as a crush from an object or most commonly the sudden stop of the hand by a wall.
The fingers are the most frequently injured part of the hand. Fingers are constructed of ligaments (strong supportive tissue connecting bone to bone), tendons (attachment tissue from muscle to bone), and 3 bones, called phalanges. There are no muscles in the fingers. Fingers move by the pull of muscles, located in the forearm, on the tendons.
The 3 bones in each finger are arranged in the same manner. The finger bones are named in their relation to the hand. For example, the first bone is the proximal phalanx. The second bone is the middle phalanx. The smallest and farthest from the hand is the distal phalanx (often injured by jamming or mallet finger). The thumb is the shortest finger and does not have the middle phalanx.
Knuckles seen on the back of the hand are joints formed by the bones of the fingers. They are commonly injured or dislocated with trauma to the hand. Each joint has a specific name depending on its location and the bones involved.
The first and largest knuckle is the junction between the palmar bones and the fingers. Medically, it is the joint of the metacarpals and phalanges. This joint commonly is injured in closed fist activities and is most commonly known as a boxer's fracture.
The next knuckle out toward the fingertip is the joint closest to the hand and between the finger bones. It is termed the proximal inter-phalangeal joint. This joint may be dislocated in sporting events when a ball or object directly strikes the finger.
The farthest joint of the finger is the distal inter-phalangeal joint. Injuries to this joint usually involve a fracture (a break) or tendon tearing (avulsion) injury.
Broken Finger Symptoms
Broken fingers rarely go unnoticed. Frequently, you have immediate pain after trauma and sometimes a deformed finger either at a joint (commonly a dislocation) or through the bone as a fracture. If there is no deformity, a sharp pain usually is felt very specifically at the injury site and will get your attention.
Sometimes you are not really sure if the finger is truly broken, and you try to bend the finger in question. A true fracture usually will be painful, but do not be fooled by a finger that has some range of motion and dull pain. Fractures are common. Depending on their stability, some may hurt more than others.
As time goes on, usually within the next 5-10 minutes, you will notice swelling and redness of the finger. The finger will become very swollen and stiff to move. Swelling is not as specific as pain and therefore may affect the adjacent fingers as well.
If the fracture is severe, bruising from released blood may be seen.
Finally, if the swelling gets too massive, numbness of the finger may occur because the nerves in the fingers are compressed.
When to Seek Medical Care
The doctor will need an x-ray to evaluate the position of the broken finger bones. The best medical treatment would be found in an urgent care facility or a hospital's emergency department. These facilities are dedicated to the care of such injuries and have the needed supplies for x-ray evaluation and splinting, when applicable.
Rarely, after a surgical procedure to stabilize the fracture, an infection may occur. The signs of this are fever, increasing redness, swelling, or severe pain of the finger, or even discharge of pus or a foul smell from the surgery site. If these symptoms occur, go to the emergency department immediately to be evaluated.
The doctor will need an x-ray to evaluate the position of the broken finger bones. The best medical treatment would be found in an urgent care facility or a hospital's emergency department. These facilities are dedicated to the care of such injuries and have the needed supplies for x-ray evaluation and splinting, when applicable.
Exams and Tests
The mainstay of diagnosing finger fractures is an x-ray. Temporary splinting, ice, and pain control are helpful supportive treatments. The type of fracture will determine the treatment. Each fracture pattern has specific characteristics that need to be addressed.
If there is a simple fracture, the doctor will splint the injured finger. He or she may put the whole hand at rest and splint the entire hand for comfort.
With more complex injuries, the doctor may seek the advice of an orthopedic surgeon (bone and joint specialist).
Broken Finger Treatment Self-Care at Home
Make a splint (immobilize your finger even if that means putting a popsicle stick or pen next to it and wrapping something around the stick and your finger).
Apply ice to the injured finger as you head to an emergency department. Do not apply ice directly to your skin. Put a towel between the ice and your finger.
Medical Treatment
Treatment of broken fingers depends on the type of fracture and individual bone in the finger that is injured. The emergency doctor or an orthopedic surgeon will assess the stability of the broken finger.
If the fracture is stable, treatment may be as simple as buddy taping (splinting 1 finger to another by taping them together) for about 4 weeks followed by an additional 2 weeks with no strenuous exercise.
If the fracture is unstable, the injured finger will need to be immobilized. Immobilization is done in several different ways.
Most simply, a splint may be applied after reduction (aligning of the fracture fragments). This usually does not maintain enough stability, and a surgical procedure may be needed.
An orthopedic surgeon has many different techniques for surgical immobilization from pinning with small wires to open procedures with plates and screws. The surgeon will discuss with you which procedure is best.
Next Steps Follow-up
You will most likely leave the hospital in some type of splint or dressing. It is very important not to disturb your splint. It is holding the fractured finger in the correct position for healing. The best thing to do is keep the dressing clean, dry, and elevated in order to decreasing the swelling.
Activity may aggravate the injury and cause increasing pain, so it is best not to use the involved hand until your follow-up appointment with your orthopedic surgeon.
Your surgeon or doctor may want to see you about one week after your injury for another x-ray to evaluate the position of the fracture fragments. It is extremely important to make this appointment. If the finger is not aligned correctly, it may affect the healing of your finger and leave permanent disability.
Prevention
The best medicine for prevention of finger fractures is safety. Most fingers are broken from machines or sporting injuries. Remember to always use safety equipment when doing activities that may injure your hands. Despite all efforts and precautions, injuries do occur and should be evaluated as soon possible.
Outlook
After reduction, immobilization, and 4-6 weeks of healing, the prognosis for the bones coming together and healing properly is excellent for a broken finger.
The most common problem encountered after treatment of fractures in the fingers is joint stiffness. By immobilizing the fingers, the capsule and surrounding tissue form scar around the joint. It becomes a race to heal the bone before the joint becomes too stiff and a decrease in motion occurs.
Many people may require physical therapy (preferably a hand therapist) for range of motion exercises. Therefore, stiffness and swelling are of great concern and may be long-term reminders of the injury. It is important to continue therapy and have a positive outlook because range of motion may continue to improve for up to a year.
Multimedia
Media file 1: Broken finger. A severe fracture of the proximal phalanx of the small finger. This bone is broken in many small fragments and very unstable. This injury occurred in an automobile accident but also can be seen in any traumatic incident. Because it is unstable, surgery was needed. In this type of injury, the surgeon may use either pins or plates and screws for repair. The pins would stay in for about 4-6 weeks, and plates and screws would be removed only if bothersome.
Media file 2: Broken finger. This x-ray shows an oblique (diagonal) fracture through the proximal phalanx of the ring finger. Notice how the fracture tends to slip or shorten (arrow). Not only does this fracture shorten, but rotational deformities are also seen. Usually it is not stable enough for just buddy taping, and surgery may be needed.
Media file 3: Broken finger. This x-ray is taken in the operating room
after pinning of a fracture similar to the one in picture 2. The x-ray shows
how the multiple small pins hold the fracture in anatomic alignment and the
shortening is gone. This will maintain stability until the fracture is healed.
The pins may be removed in 4-6 weeks.
Media file 4: Broken finger. A typical fracture at the end of the small
finger metacarpal is shown in this x-ray. The fragment is most always flexed
toward the palm as seen in this x-ray. Most typically this fracture is caused
by a closed fist striking an object. This commonly is called a boxer's (or
brawler's) fracture. Treatment of this fracture usually is conservative
casting. Don't be alarmed by the angulation of the bone. It is usually only
cosmetic, and hand function should be normal after the bone heals.
Media file 5: Broken finger. This x-ray illustrates a common fracture
of the distal phalanx. It is an injury where the distal phalanx is forced
toward the palm and resisted by the pull of the extensor tendon. This is very
common in sporting events in which a ball strikes the end of the finger (often
called mallet finger). These injuries are either bony (as seen) or involve
ligaments. Treatment is splinting or surgical pinning of the distal phalanx.
This injury may take a long time to heal and must be watched closely. Despite
every effort to heal, a residual lag may continue after treatment. This usually
is cosmetic only and does not affect grip strength.
Media file 6: Broken finger. This is an x-ray of an oblique (diagonal)
fracture of a metacarpal. These injuries occur from a twisting or crush injury
to the hand. They are common to machining and workplace injuries as well as
direct trauma. There are many different muscles and tendons that may accentuate
this fracture causing shortening or angulation toward the palm. Treatment may
consist of either casting with close observation or a surgical procedure for
stability of the fracture. This would depend on the severity of the fracture
seen on the x-ray.
[h3]Synonyms and Keywords[/h3]
finger
injuries, digit,
phalanx,
metacarpal,
index finger, long finger, ring finger, small finger, thumb
fracture, mallet
finger, finger
infection, broken
finger
I think I covered everything.
