Finger Fracture

Background

A finger fracture results from either blunt trauma directly to the digit, or from a torsional force. The fracture pattern reflects the injury mechanism in most cases. There are many elements that are important to consider when treating these, including the patient’s activity level, medical history and specifics as they relate to the fracture itself, such as rotation, angulation and shortening.

Causes

These fractures usually result from blunt force or torsional trauma. Higher energy mechanisms are also possible, such as injuries from gunshots, nail guns, and crush injuries.

Symptoms

Finger fractures cause pain, tenderness, and swelling over the affected digit. If the fracture is displaced, there may be a visible deformity such as angulation or malrotation called scissoring.

Diagnosis

The injured hand is assessed. Range of motion is typically diminished, in conjunction with bruising and swelling. X Rays are critical to make the diagnosis and help guide treatment.

Treatment

Minimally displaced fractures can be braced or casted. Displaced fractures may require surgery which usually entails lining the bone up properly, and placing a plate and screws to stabilize the fracture while it heals. Closed manipulation (without incision) and placement of temporary pins is also an established technique. Depending on the fracture pattern, placement of a device such as an intramedullary nail or cannulated headless screw can be considered. Open fractures usually require surgical intervention.

Three small lag screws to repair a spiral fracture of a proximal phalanx.

This is the case of an intraarticular fracture of the proximal interphalangeal joint. These can be difficult to treat well. We used a dynamic external fixator that allows for immediate motion. The wires are removed after 4-6 weeks.