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Broken Knuckle or Fractured Knuckle: Causes, Symptoms, Treatment, Prevention

About Broken Knuckle or Fractured Knuckle!

Knuckles are the joint between fingers and hand, which become prominent when hand is clenched. The bone of finger known as phalanx forms joint with the bone of hand known as metacarpal bone. There are 5 knuckle joints and 10 knuckle bones in each hand. Knuckle bones(1) are the head of the metacarpal bone and phalanxes. Knuckles arguably can be called as the hardest bones of the hands but interestingly enough even knuckles can at times break or fracture causing very unpleasant and discomforting experience when hand is close to make a fist. A bones forming knuckle can break usually after hitting a pretty hard surface with a full fist like a wall or floor. The head of the metacarpal bone and phalanx forming knuckle are the hardest bones of the hand, and yet these knuckle bones can break or fracture if an individual makes a full fist and hits at a hard object like a wall or a floor.

Broken knuckle or fractured knuckle usually occurs during fist fight and street fight. A Broken Knuckle is extremely discomforting and painful. It affects the daily activities of a person. Usually, a Broken Knuckle or Fractured Knuckle may not need surgical treatment. Conservative treatment like ice packs and rest helps to relieve severe knuckle pain.

Broken Knuckle or Fractured Knuckle

What Are The Causes of Broken Knuckle or Fractured Knuckle?

Majority of cases of Broken Knuckles are caused as a result of the hand hitting a hard object like a floor or a wall.

  • Domestic Violence. Broken knuckle or fractured knuckle may also occur during a fight or a brawl. It is very rare for more than one knuckle to break at one time but it may happen. Usually the knuckle most susceptible for breaking is the one which is closest to the little finger.
  • Contact Sport. The fracture of knuckle bone is occasionally observed in athletes participating in contact sports. The fall with stretched arm and clenched fist while paying soccer, football or rugby may result in fracture of knuckle bone.
  • Work Accident. Manual working may sustain in knuckle injury or knuckle fracture following a fall from height while holding object in hand or when hard object strikes against clenched fist.
  • Automobile Accident. Serious automobile accident may cause a fracture of clenched fist and knuckle.

What Are The Symptoms of Broken Knuckle or Fractured Knuckle?

Some of the Symptoms of a Broken Knuckle or Fractured Knuckle are:

What Are The Symptoms Of Broken Knuckle or Fractured Knuckle?

  • Severe pain immediately following the injury
  • Difficulty making a fist
  • Severe swelling so much so that moving the hand becomes difficult
  • Bruising
  • Numbness
  • Stiffness.

How Can Broken Knuckle or Fractured Knuckle Be Diagnosed?

In case of a Broken Knuckle, there will be excruciating pain at the injured site along with swelling. The best way to find out if there is a Broken Knuckle or not is to try and clench the fist. In cases of a Broken or a Fractured Knuckle, the fingers will not bend normally. An x-ray of the hand will confirm a Broken Knuckle.

  • Examination: The examination of knuckle may indicate bruising and skin injuries. The touch and pressure will generate severe pain. The primary care physician or ER physician will almost in all cases able to diagnose the fracture knuckle just following examination of hand and knuckle.
  • Radiological Studies: The X-Ray and CT scan will confirmed the clinical diagnosis(2) of fracture of knuckle bone.

How is Broken Knuckle or Fractured Knuckle Treated?

The non-displaced knuckle fracture is treated with conservative treatment and pain medications. The displaced knuckle fracture resulting in separation of fractured segment of the bone is treated surgically.

Conservative Treatment of Broken Knuckle or Fractured Knuckle

Following conservative treatments are tried before medication and surgical treatment:

  • Heat and Cold Therapy: The pain caused by non-displaced knuckle fracture is treated with cold pack placed over fracture site for 20 minutes every 2 to 3 hours. In few cases, if cold is not tolerable then heat treatment is tried. Heat is not directly applied to fracture site but to surrounding muscle and tendon of the hand.
  • Immobilization:(3) The non-displaced knuckle fractured hand is immobilized for 3 to 6 weeks or until fracture is healed. The fist is immobilized by applying braces to maintained hand in fist position.

Anti-inflammatory Medications Treatment for Broken Knuckle or Fractured Knuckle

Pain and inflammation of surrounding soft tissue is treated with anti-inflammatory medications. NSAIDs anti-inflammatory medications are prescribed for 10 days to 15 days. Pain is not treated with opioid medications.

Surgical Treatment Broken Knuckle or Fractured Knuckle

Surgical treatment is necessary when fracture knuckle bones are displaced and separated.

  • Plate Fixation: In this procedure, metal plates are placed at the fracture site to hold the broken knuckle bones together in place with the help of screws.
  • External Fixation: In this procedure, pins are inserted into the fractured knuckle bones to fix them. The pins are left till the broken knuckle bones heal and then removed.

Treatment of Broken Knuckle or Fractured Knuckle Without a Doctor

Some cases of Broken Knuckle or Fractured Knuckle often causes only symptom like pain. The knuckle fracture is either hairline and non-displace. Individual should see a physician before considering conservative treatment. Following home remedies do help in few selected cases of broken knuckle or fractured knuckle:

  • Clean Open Wounds: The wounds need to be washed with antiseptic so that there is no chance of an infection developing. Once the wound is cleaned, a dressing can be placed to cover the wound.
  • Ice Pack: An ice pack can be wrapped around the injured site. It can be painful to begin with but it reduces the swelling and inflammation.
  • Elevate Knuckles: One can place the hand above the level of the heart to reduce swelling and inflammation.
  • Strapping with Adjacent Finger: Once the swelling and inflammation has calmed down, the injured site can be strapped to the adjacent finger to keep the knuckles straight for approximately two to three weeks for the fracture to heal.
  • Splint: it is an important way to keep the broken area straight by strapping it to the adjacent finger.

What Are Some Ways to Prevent Broken Knuckles?

As the saying goes “Better Safe Than Sorry”, the best way to prevent Broken Knuckles or Fractured Knuckle is to play safe and take proper safety measures. Injuries are accidental or intentional. Intentional injuries can be prevented. Do not strike hard on any object with close fist. Avoid contact sport and if one does participate then make sure to avoid using fist hand with outstretched arm while falling on hard surface. Broken Knuckles are often caused by sporting injuries, fights, falls and work injuries. Staying away from getting involved in street fights or fist fights is the best way to prevent oneself from not only breaking the knuckles, but as well as preventing other body injuries.


Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:December 29, 2020

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