Fingers have a very important role to play in the daily life of an individual. Fingers helps an individual with gripping and grasping an object, they are used for touching things, as well as play an important role in interaction, which makes them vulnerable to injuries. Finger injuries vary from being a little as just a bruise or a contusion to as big as a fracture of the bones of the finger or a dislocation.
If one is to understand the construction of a finger, it is made up of tendons that are the tissues which is responsible for attaching the bone to the muscle. The bones in the fingers are called as phalanges and they are connected to one other by ligaments. There are no individual muscles in the fingers; in fact, the muscles of the forearm are attached to the fingers with tendons, which allows them to move.
There are three bones, called proximal phalanx, the middle phalanx, and distal phalanx, in the fingers and they are arranged in a sequential manner..
The term broken finger is given when any one of the three bones of the finger sustain a fracture. The fingers are more prone to fractures than the thumb.
In the case of a simple fracture to any of the bones, then the treatment is pretty simple and healing is quick. Complications occur only when the fracture is situated near the joints, which makes it difficult to treat.
A finger fracture is quite a common phenomenon in contact sports but they also occur with other sporting incidences such as when skiing, skateboarding etc. This can be protected with appropriate protective gears like gloves etc.
Causes of Broken Finger or Fractured Finger
- The major cause of a mid finger fracture and broken fingertip is a direct trauma or a direct fall on the finger.
- An individual may also experience a broken finger tip or broken mid finger if person is trying to prevent a fall by extending arm and jamming the hand in to ground or object in front during the course of fall.
- Contact sport most often causes fingertip fracture than mid finger fracture.
- A finger tip fracture or mid finger fracture may result when the finger is deliberately and forcefully twisted backwards by an individual or during an accidental fall when individual is unaware of fall resulting on extended arm and twisted finger.
- Fracture of phalanges causing fingertip or mid finger fracture is seen following work accident when individual is using heavy equipment like drills or power saws.
- Conditions like osteoporosis and deficiency of calcium in the bone may also result in finger fractures. Mid shaft phalanges fracture is more common than fingertip fracture in patients suffering with osteoporosis.
- Pain- The finger fracture includes fracture of proximal, middle or distal phalanges. The pain at the tip of the finger suggests fracture that involves distal phalanx and this fracture is known as fingertip fracture. The pain in middle of finger is caused by fracture of middle phalanx and pain near the knuckle of the hand is caused due to fracture of proximal phalanx. The pain is acute and sudden associated with swelling of the finger.
- Finger Discoloration and Swelling- The finger discoloration and swelling is localized over the fractured site. The swelling and discoloration of fingertip with severe pain suggest fingertip of distal phalanx fracture. Similarly swelling and skin discoloration over middle finger or proximal finger near knuckle suggests fracture of middle or proximal phalanx of the finger.
- Finger Movement- Finger movements are restricted and painful. Finger flexion is associated with clicking sound.
- Lifting or Gripping Objects- Patient is unable to lift or grip the hand or finger because of pain and restricted flexion as well as extension of injured finger. Patient may be able to hold object with pain if fracture is of fingertip or distal phalanx fracture. The mid and proximal phalanx fracture is associated with difficulties in holding the objects. Patient is unable to make a grip. Pain is felt while lifting or gripping an object.
- Finger Deformity- The finger deformity of the tip of the finger suggests fingertip fracture; similarly deformity of mid finger and base of the finger suggests fracture of mid or proximal finger.
- Fracture Malalignment- Healing of fracture following conservative treatment often results in malalignment of two fracture ends. The malaligned finger looks bend and crooked. If the deformity is observed at the tip of the finger then the cause of deformity is misaligned healing of fingertip fracture. Similarly mid and proximal finger fracture looks misaligned when fracture is healed with deformity.
- Tingling and Numbness- Patient often complains of tingling and numbness with pain. The pressure and irritation of digital nerve causes symptoms like tingling and numbness. Depending on the level of fracture, symptoms like tingling and numbness is felt over tip, middle, or proximal end of finger.
Conservative Treatment for Broken Finger-
- Heat Application- Fingertip fracture often responds well to conservative treatment. Pain is treated with heat application. Heat is applied as an infrared therapy or application of hot water bag. Heat treatment is advised after 48 hours to prevent continuation of subcutaneous bleeding. Heat treatment is avoided if finger is discolored and blood is collected under the skin. The bleeding causes swelling and stretching of the skin, which results in severe pain.
- Cold Therapy- Cold therapy is preferred immediately following injury to prevent or slow down the bleeding. Pain intensity is also reduced after cold therapy. Cold therapy involves application of ice bag or direct ice.
- Use of Braces- Hairline and non-displaced stable fracture is treated with braces. Tip of the finger fracture responds well to braces if two fracture ends are in anatomical position. The mid phalanx and proximal phalanx may need surgical treatment.
Medications for Broken Finger-
- Pain Medications- Pain is often severe following injury. Pain is treated with NSAIDs or Opioids. Severe finger pain may not respond to NSAIDs. Most common opioid used for fingertip fracture is hydrocodone. The pain caused by mid shaft or proximal phalanx fracture may not respond to hydrocodone and patient may need to be treated with oxycodone or morphine.
- Muscle Relaxants- Fracture and pain triggers muscle contraction of hand and fingers. Continuous muscle contraction results in muscle spasm, which increases the pain intensity. If there is an evidence of muscle spasm of hand muscles then the muscles spasm should be treated with muscle relaxants. Most effective muscle relaxants used to treat most traumatic spasm is Flexeril or Skelaxin.
- Non-Steroidal Anti-Inflammatory Medications- NSAIDs are anti-inflammatory medications and effective in treating inflammation. NSAIDs are recommended after 72 hours once severe pain following fracture is subsided. NSAIDS are prescribed for 5 to 10 days depending on signs of inflammation.
Physical Therapy For Broken Finger-
Physical therapy is advised after the fracture is healed. Physical therapy is essential to build the strength of the muscles and ligaments of the hands and finger. Patient often needs 4 to 6 weeks of physical therapy under close supervision of physical therapist.
Close Reduction of Fracture-
Most of the displaced finger fracture involving fingertip, mid phalanx or proximal phalanx are treated with close reduction. Close reduction is performed under local anesthesia or sedation. The fracture ends are pulled apart manually or by using special equipment. Once the pulled fracture ends are set in normal anatomical position then cast is applied over the finger or position is maintained using special braces. Finger is immobilized for 4 to 6 weeks. Finger is frequently examined with X-Ray to evaluate the healing of the fracture end.
Surgery For Broken Finger
Surgery is indicated when displace fracture is unstable and failed to reduce and maintain in normal position. Surgery is also indicated when fingertip fracture failed to heal by conservative treatment. In few cases surgery is advised when close reduction fails to realign fracture end or maintain normal position following application of cast. Following surgical procedure are advised-
- External Fixation- Two screws are passed through skin in to proximal and distal fracture fragments. External fixator is used to pull the wire or screw holding fracture fragments so as align fracture end and maintain the pulled until two end wound heals with calcification (calcium deposits) and ossification (new bone formation).
- Internal Fixation- Internal fixation is performed by inserting wire from proximal fracture fragment to distal fracture fragment. The wire holds the two fragments together. Wire is removed once fracture is healed. Such treatment is beneficial for fingertip fracture. The mid shaft and proximal fracture(4) is also treated with placing wire through two fracture fragments. Alternatively mid shaft and proximal fracture is treated with placement of plate over fractured phalanx, which holds both fractured fragments in normal anatomical position. The plate is fixed to the bone by inserting screw through plate into fractured fragment bone.
Post Surgery Rehabilitation for Broken Finger
Patient is treated with physical therapy following healing of the fracture. In few cases if the fracture is caused by work accident then patient is re-trained for same or different job in rehabilitation center by occupational therapist.
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