Finger Fractures

Finger fractures are a common problem that we see every week.  We use her hands for almost every single activity and so it is not unusual and at they become injured in accidents at home, work and sporting activities. the mechanism of injuries range from falls to crushing injuries. fractures may be open, with the bone sticking out or exposed, or closed.  Fractures may be clean or contaminated. Fractures may be well aligned (nondisplaced) or displaced with rotation or angulation deformities of the finger.  Fractures may be a simple two-part fracture or comminuted with multiple pieces.  every finger fracture is different due to its location, orientation level of comminution.  This is known as the fracture personality.  with a fracture is produced there is also damage to the surrounding soft tissue, such as bone covering or periosteum, tendons, ligaments, joints and skin.  Often it is the soft tissue damage and resultant healing with scar tissue that becomes more of a problem after healing.  Treatment of "soft tissue disease" is therefore important as well is treating the bony fracture. the patient who sustained the finger fracture is also important.  Factor such as patient age, general health, nutrition, smoking all affect fracture healing.

Careful assessment of the hand is critical to preparing a successful treatment plan.  The exact nature of the fracture is assessed with multiple x-rays and possible advanced imaging studies such as CT scan.  A determination  is made whether the fracture is stable or unstable, secondary to its location and the muscle forces acting on the fracture.  A decision is made whether the fracture is sufficiently well aligned or must be corrected(reduced) in order to prevent deformity.  A decision is made as to the technique that may past reduce the fracture and allow appropriate rehabilitation(pins, screws, plates or an external fixator). The nature and extent of soft tissue damage to the fingers also assessed.  In some cases the soft tissue damage will not allow immediate fixation of the fracture and must be addressed first by further healing, flap or skin grafting.  Accompanying tendon injuries or nerve injuries also affect decision-making in fracture care.

In broad general terms , simple nondisplaced fractures with minimal soft tissue disease are usually treated conservatively with a protective cast, splint or buddy taping of two fingers together to protect the fracture while healing.  Gentle active range of motion to prevent stiffness may be initiated in therapy if the fracture is stable.  Unstable fractures may need to be protected longer until motion is started.  Fractures that are displaced with disruption of a joint (intra-articular extension) or deformity caused by rotation and angulation of the fracture are usually treated by surgical fixation.  At surgery, the fracture is either fixed by straightening the finger and placing small pins through the skin and across the fracture to stabilize it.  This is known as a closed reduction and percutaneous fixation. when this is not possible an open reduction and internal fixation (ORIF) is performed.  A small incision is made over the fracture to directly expose it and small pins, screws or plates are utilized to correct the fracture deformity.

After surgery the patient is placed in a protective splint  and therapy is usually initiated to help regain and maintain finger motion. we prefer her more rigid fixation of the fractures so that we can begin more aggressive range of motion early when possible.  This helps to avoid the "soft tissue disease" and scarring the often produces more problems than the original fracture.  At this point it carefully critical that the patient be compliant, faithfully attend therapy and work hard in order to regain motion and function.  I explain to patients that 50% of the result is the result of our work at surgery and that 50% is the result of the patient's workup therapy.  Both are critical for a good result. once the fractures have healed, the splints may be discontinued and more aggressive motion exercises and strengthening exercises begun.  In some cases additional surgery to release scar tissue around the joints or tendons may be required to fully regain finger function, even though the fracture is healed with good alignment.