Finger fractures – i.e. a break in one of the 14 bones in the fingers - are a common problem that we see every week. This is not surprising, considering that we use our hands for a wide range of activities. As a result, our fingers are at a high risk of being injured in accidents at the home, at work, and during sporting activities.

Unfortunately, following an injury, our activity can become severely limited due to the loss of mobility in our hand(s). Additionally, a single finger fracture can ruin the delicate alignment of a hand, and may lead to long-term problems without proper care.

The Causes

Finger fractures can be caused by a range of accidents, including falls and crushing-related injuries. This means that fingers are just as likely to be damaged in a fall (if we land on our hands the wrong way) as they are due to being crushed (which can happen if a hand is caught between two objects, in a car door, etc.).

The Types of Fractures

Fractures of the finger can manifest in a variety of ways, each requiring a specific type of care to allow the fracture to heal properly.

  • Finger fractures may be open (i.e. with the bone sticking out and/or exposed) or closed (i.e. contained within the skin). 
  • Fractures may be clean (i.e. limited to a singular break) or contaminated (i.e. fragmented in many pieces).
  • Fractures may be well aligned (i.e. nondisplaced) or displaced (i.e. creating visible rotation or angulation deformities of the finger). 
  • Fractures may be a simple two-part breaks, or may be comminuted (i.e. fractured into multiple pieces and particles).

In addition to potentially breaking in a variety of ways, every finger fracture is also different due to its location and orientation level. This is known as the fracture personality

The Damage of a Fracture

A fracture alone is not the only thing that needs to be treated. Following injury, there is also damage to the surrounding soft tissue, such as bone coverings 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 just as important as treating the bony fracture. Treatment must also consider factors such as a patient’s age, general health, nutritional intake, and smoking history. All of these factors can affect fracture and soft tissue healing needs and expectations.

The Diagnosis & Treatment

Careful assessment of the hand is critical to preparing a successful treatment plan. The exact nature of each individual fracture is assessed with multiple x-rays and possible advanced imaging studies such as CT scan. Through testing, all of the following is evaluated:

  • A determination is made about whether the fracture is stable or unstable, secondary to its location and the muscle forces acting on the fracture.
  • A decision is made on 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 best 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.

Conservative Treatment

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. Additionally, a 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 exercises are started. 

Surgical Treatment

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. 

During surgery, the fracture is 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, however, an open reduction and internal fixation (ORIF) is performed. In these cases, 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.

The Recovery

After surgery, a patient is placed in a protective splint and therapy is usually initiated to help regain and maintain finger motion. Note that at Pittsburgh Foot & Hand Center, we prefer more rigid fixation of the fractures so that we can begin more aggressive range of motion early when possible. This helps to minimize the "soft tissue disease" and scarring that often produces more problems than the original fracture. 

At this point in recovery, it’s critical that the patient be fully compliant, that they faithfully attend therapy, and that they work hard in order to regain motion and function. I, Dr. Bowman, always 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.