Broken finger

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Broken finger
Other names: Finger fracture; phalanx fracture
MalletFinger.PNG
A mallet finger due to an avulsion fracture
SpecialtyEmergency medicine, plastic surgery
SymptomsPain, bruising, deformity, reduced ability to move the finger[1]
ComplicationsLong-term pain, stiffness, decreased function[2]
CausesInjury, pathological fracture[3]
Diagnostic methodX-rays[3]
Differential diagnosisFinger dislocation[3]
TreatmentBuddy taping, splinting, surgery[3]
Frequency1 in 10,000 per year[3]

A broken finger, also known as a finger fracture, is a bone fracture affecting one of the three bones of the finger or two bones of the thumb.[3] Symptoms may include pain, swelling, bruising, deformity, and reduced ability to move the finger.[1] Complications may include long-term pain, stiffness, and decreased function.[2]

The cause is usually a traumatic injury, such as a direct blow, crush, or cut.[1][3] This may occur during a fall or sports injury.[3] Pathological fractures, from an infection or a tumor, are less common.[3] Diagnosis is generally based on X-rays.[3] Examination should include looking for overlap between fingers.[3]

Treatment may include buddy taping, splinting, or surgery.[3] Surgery is generally not needed for for stable fractures that do not involve the joint, tuft fractures, and mallet fingers.[2] Unstable fractures, those that involve a joint, or those with tendon problems, may benefit from surgery.[2] Surgery may include placement of a K-wire.[3] Outcomes are generally good.[3] A broken finger is relatively common affected about 1 in 10,000 people a year in the United States.[3] Males are more commonly affected than females.[3]

Signs and symptoms

This broken little finger is unnaturally angulated.

Symptoms include pain, swelling, deformity, decreased range of motion, and instability. There may be pain when the injury is probed.[3]

Sensation is checked to look for nerve damage, and capillary refill for blood circulation damage. The hand is also checked for injuries to the soft tissues, like sprains and tendon tears, and for dislocations to the joints, because these may have been caused at the same time.[3]

Complications

Some finger fractures are severe enough to need surgery. In these severe cases, complications often occur, but most eventually heal functionally. Rarely, there are long-term complications, including decreased range of motion and deformity.[3]

A break that affects the joint surface may be displaced so that there is a step in the joint surface, which should be smooth. This will hinder motion and risks post-traumatic osteoarthritis, so it is usually reduced (put back in place) surgically. If the fracture is unstable (won't stay reduced), or a joint is dislocated or partially dislocated, hand surgeons agree it should be surgically repaired. Open fractures, in which the skin is broken, also increase the risk of infection and complications, especially if the wound is dirty or parts have to be removed.[3] Open fractures are usually operated on.[3]

A Busch fracture is a specific type of finger fracture where the base of a distal phalanx is affected.[4] Without adequate treatment, it can become a mallet finger.

Causes

Putting out a hand to break a fall and landing badly can fracture a finger.[1] Crushing injuries may occur when a finger gets shut in a door (most common among children under eight), or in an accident with machinery or a heavy object.[3] A jammed finger (a trauma from a blow on the end of the finger) is often caused by trying to catch a ball and may break the finger. Misusing tools, especially power tools,[1] can also break fingers.[1]

Occasionally, an infection or tumour can cause a broken finger;[3] this is called a pathological fracture.

Mechanism

Location

Finger fractures are identified by the bone on which they occur. Fingers are numbered 1 to 5, with 1 being the thumb. The distal (tip) finger bones are divided into tuft (the very tip of the bone, at the end of each finger), shaft (the thinner middle section), and base. The rest of the finger bones (the middle finger bones, and the proximal or innermost finger bones) are divided into base, shaft, and condyle (outer end). Extensive tendons surround the joints and move the fingers. On the front and back of each finger is a digital nerve and artery; these can also be injured when the finger is broken.[3]

The AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification generates language-neutral numeric codes for describing broken fingers. They run 78[meaning a fracture of the phalanges of the hand].[number-code of the finger, with thumb=1 and the little finger=5].[number-code of phalanx, counting 1 to 3 outwards from the hand].[number-code of location on the bone, with 1 being the inner end, 3 the outer, and 2 in-between]. So, for instance, 78.1.1.1 means a fracture to the thumb's innermost bone, at the inner end (the base of the thumb). A letter can be added to describe the fracture pattern.[5]

Fracture patterns

Multiple fractures to the tip of a finger; this might happen if it were hit with a hammer

If the blow that breaks the bone bends it sideways, it will usually cause a transverse fracture, a break across the finger. A force at an angle is likely to produce an oblique fracture, and a twisting force is more likely to cause a spiral fracture. Crushing injuries may or may not shatter the bone into multiple pieces, which is called a comminuted fracture.[3]

Fractures in the joints are often caused by jammed finger injuries, the hand equivalent of a stubbed toe. If a tendon pulls away the bit of bone to which it is attached (an avulsion fracture, shown in the image at the top of the page), that will also lead to a fracture in a joint.[3]

Prevention

Prevention includes using protective equipment, avoiding unsafe use of tools and machinery, safety closers to avoid children's fingers being caught in slammed doors, and fall prevention. In sports, prevention includes gloves and avoiding high-hand-risk situations.[3]

Treatment

Broken fingers are treated in emergency if the broken finger is blue or numb, if the fracture is displaced (the finger is at an angle to where it should be), or if bone is visible in or through the wound.[6]

Extraction

Removing a ring

If a broken finger is trapped in an object, it must be freed[7] in a way that avoids further injury. Relaxation, elevation, icing, and lubrication (e.g. soapy water or oil) may suffice. If not, removal by other methods[clarification needed] can be done by a doctor; if the object is not portable, it is often done by paramedics or the fire department.[8]

As with other hand injures, any rings or bracelets are removed immediately, before the injury starts to swell.[7] Pulling rings off forcefully may worsen the swelling. Relaxation, elevation, icing, lubrication, and rotating the ring as if unscrewing it may help. If these methods don't work, it may be possible to remove the ring by temporarily wrapping the finger with a slick string (something like dental floss), passing the inner end of the thread under the ring, and then unwrapping it, pushing the ring ahead of the unwrapping string. Failing that, a doctor may remove it by other methods.[9]

Splinting

Buddy-taped fingers:
the broken finger is taped to the next unbroken finger,
with padding, so that it splints it and reduces pain.

A broken finger may or may not require surgery. In simple cases, the bone may be put back in place and the finger may then be put in a splint, or strapped to another finger ("buddy taping").[2]

If the wrap that splints the finger is too tight, there is a risk of compartment syndrome. If the finger is numb, tingling, more painful, more swollen, or if the skin below the wrap is cool to the touch, the wrap may need loosening.[7]

The splint needs to be kept dry and may interfere with daily tasks, which will need to be done by someone else.[10]

Re-alignment

Many finger fractures are not displaced. Simple displaced fractures may be re-aligned (reduced) with a local anesthetic.[6]

Surgery may be needed for an unstable fracture (one that won't stay in the right place once reduced),[2] a finger broken in multiple places,[6] a fracture that extends into the joint between the broken bone and another bone, and a fracture with damaged tendon function[2] or damaged nerves.[6]

Pain reduction

Rest, ice, and elevation can be used to reduce pain. Icing is done for 15 to 20 minutes every 2 to 3 hours,[6] or 10–20 minutes every 1–2 hours.[10] Ice isn't placed directly on the skin, but wrapped first,[6][10] in thin cloth[10] such as a teatowel.[6] Icing is done while awake, for the first three days or until the swelling goes down.[10] Elevation can be done by resting the hand upon a cushion or pillow,[6] and trying to keep it above the heart as much as reasonably possible.[10] An over-the-counter painkiller like paracetamol or ibuprofen can also be used.[6]

Prognosis

Broken fingers and thumbs usually heal in 2–8 weeks, with 3–4 months for full strength.[6] Fingers mostly heal well in 3–4 weeks. Eating healthily and not smoking can speed healing. Pain should steadily decrease, with improvements starting within a few days of the injury.[10]

If it does not steadily improve, or if tingling, weakness, numbness, or signs of infection appear, it needs further treatment; see complications, above.[10]

Epidemiology

Broken fingers affect 0.012% of people per year in the United States. Finger fractures are common in children and old adults, but less common in the 45 to 85 age range. More male children break their fingers; in adults, only slightly more males. Wealthier people are less likely to break their fingers.[3]

The proximal (wristwards) finger bones are those most likely to be broken, and the smaller fingers are more likely to be broken than the index finger and thumb.[3]

See also

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 "Finger Fractures - OrthoInfo - AAOS". www.orthoinfo.org. Archived from the original on 2023-10-22. Retrieved 2023-10-28.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Oetgen, Matthew E.; Dodds, Seth D. (December 11, 2007). "Non-operative treatment of common finger injuries". Current Reviews in Musculoskeletal Medicine. 1 (2): 97–102. doi:10.1007/s12178-007-9014-z. PMC 2684218. PMID 19468880.
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 McDaniel, Dalton J.; Rehman, Uzma H. (November 2, 2021). "Phalanx Fractures of the Hand". StatPearls. StatPearls Publishing. PMID 32491557. Archived from the original on December 29, 2020. Retrieved October 28, 2023 – via PubMed.
  4. Giovanni De Bastiani; Alan G. Apley; Anthony A.J. Goldberg (6 December 2012). Orthofix External Fixation in Trauma and Orthopaedics. Springer Science & Business Media. pp. 883–. ISBN 978-1-4471-0691-3. Archived from the original on 14 January 2023. Retrieved 28 October 2023.
  5. Meinberg, Eg; Agel, J; Roberts, Cs; Karam, Md; Kellam, Jf (January 2018). "Fracture and Dislocation Classification Compendium—2018" (PDF). Journal of Orthopaedic Trauma. 32 (1): S1–S10. doi:10.1097/BOT.0000000000001063. PMID 29256945. S2CID 39138324. Archived (PDF) from the original on 2022-03-31. Retrieved 2023-10-28., page 87 of PDF fulltext
  6. 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 "Broken finger or thumb". nhs.uk. October 17, 2017. Archived from the original on March 22, 2023. Retrieved October 28, 2023.
  7. 7.0 7.1 7.2 "Finger, Hand, and Wrist Injuries". HealthLink BC. Britich Columbia Ministry of Health. Archived from the original on November 13, 2021. Retrieved November 13, 2021.
  8. "Trapped Finger, Toe, or Limb". HealthLink BC. Archived from the original on 13 November 2021. Retrieved 13 November 2021.
  9. "Removing a Ring From a Finger or Toe". HealthLink BC. Archived from the original on November 13, 2021. Retrieved November 13, 2021.
  10. 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 "Finger Fracture: Care Instructions". myhealth.alberta.ca. Archived from the original on 14 November 2021. Retrieved 14 November 2021.