Finger Fractures

Fingers explore the environment, hold on to objects, and can easily be squashed, trapped, grabbed or twisted. As a result, they frequently get in the way and can be injured. Trapped in doors, hit by hammers, crushed, twisted or bent, broken bones in the fingers are common.

There are 3 bones in each finger, called phalanges. Fractures can occur in the shaft of a phalanx, or onto the joint surface itself (called articular fractures). Shaft fractures need to heal in a position that lines up the joints at either end correctly. Articular fractures must be pieced back together again to make a smooth surface once more.

If shaft fractures are not correctly reduced (the name given to the process of moving the broken fragments back to their original shape), the fractures will heal in an unacceptable position. This may be angulated (bent to one side), shortened (when the fragments overlap and the bone heals shorter than before), or rotated (where the fingers cross over each other when they bend). Doctors use a combination of clinical examination and x-rays to assess the position of a fracture before making a decision on whether or not this is acceptable.

Articular fractures require more accuracy in their reduction. If an articular fracture heals leaving a significant step on the joint surface, then the joint (just like any moving machine part) will not function well, may be painful and will wear out quickly.

The majority of finger fractures require observation only until they heal (usually around 3 to 4 weeks after injury). Some fractures require reduction into an acceptable position. A judgement must then be made if the fragments are likely to displace again. These fractures are called unstable and may require help to keep the fragments in place until they heal. Sometimes this is done by surgically inserting small, smooth pins (called Kirschner wires, or K-wires), or even small metal plates and screws through an incision. Screws as small as 1 mm diameter are manufactured for this purpose. Many of these implants remain in the body forever.

Fractures will make the fingers stiff. Not only will the injured finger be stiff, but all fingers in the hand suffer from the lack of use. Exercises are advised or, in some cases, physiotherapy is arranged. Most simple fractures heal with few long term problems, but complications do occur, such as permanent stiffness, malunion (healing in the wrong position) or non-union (where the fragments fail to join together). Long term risks include early arthritis after articular fractures.

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