Broken finger

Last updated
Broken finger
Other namesFinger fracture
MalletFinger.PNG
Specialty Emergency medicine
Symptoms inflammation, tenderness, bruising, deformity, reduced ability to move the finger
Usual onsetSudden
Causes traumatic injury
Frequency0.012% of people per year in the United States. [1]

A broken finger or finger fracture is a common type of bone fracture, affecting a finger. [1] Symptoms may include pain, swelling, tenderness, bruising, deformity and reduced ability to move the finger. [2] Although most finger fractures are easy to treat, failing to deal with a fracture appropriately may result in long-term pain and disability. [3]

Contents

The cause is usually traumatic injury. [2] These are most commonly falls, crushing injuries, and sports injuries. Pathological fractures, from an infection or a tumour, are rarer. [1]

Anatomy

Location

Finger fractures are identified by the bone on which they occur. Fingers are numbered 1 to 5, with 1 being the thumb. The distal (tip) finger bones are divided into tuft (the very tip of the bone, at the end of each finger), shaft (the thinner middle section), and base. The rest of the finger bones (the middle finger bones, and the proximal or innermost finger bones) are divided into base, shaft, and condyle (outer end). Extensive tendons surround the joints and move the fingers. On the front and back of each finger is a digital nerve and artery; these can also be injured when the finger is broken. [1]

The AO Foundation/Orthopaedic Trauma Association (AO/OTA) classification generates language-neutral numeric codes for describing broken fingers. They run 78[meaning a fracture of the phalanges of the hand].[number-code of the finger, with thumb=1 and the little finger=5].[number-code of phalanx, counting 1 to 3 outwards from the hand].[number-code of location on the bone, with 1 being the inner end, 3 the outer, and 2 in-between]. So, for instance, 78.1.1.1 means a fracture to the thumb's innermost bone, at the inner end (the base of the thumb). A letter can be added to describe the fracture pattern. [4]

Fracture patterns

Multiple fractures to the tip of a finger; this might happen if it were hit with a hammer Nagelkranzfraktur.jpg
Multiple fractures to the tip of a finger; this might happen if it were hit with a hammer

If the blow that breaks the bone bends it sideways, it will usually cause a transverse fracture, a break across the finger. A force at an angle is likely to produce an oblique fracture, and a twisting force is more likely to cause a spiral fracture. Crushing injuries may or may not shatter the bone into multiple pieces, which is called a comminuted fracture. [1]

Fractures in the joints are often caused by jammed finger injuries, the hand equivalent of a stubbed toe. If a tendon pulls away the bit of bone to which it is attached (an avulsion fracture, shown in the image at the top of the page), that will also lead to a fracture in a joint. [1]

Causes

Putting out a hand to break a fall and landing badly can fracture a finger. [2] Crushing injuries may occur when a finger gets shut in a door (most common among children under eight), or in an accident with machinery or a heavy object. [1] A jammed finger (a trauma from a blow on the end of the finger) is often caused by trying to catch a ball and may break the finger. Misusing tools, especially power tools, [2] can also break fingers. [2]

Occasionally, an infection or tumour can cause a broken finger; [1] this is called a pathological fracture.

Signs, symptoms and diagnosis

This broken little finger is unnaturally angulated. Broken finger.jpg
This broken little finger is unnaturally angulated.

Symptoms include pain, swelling, deformity, decreased range of motion, and instability. There may be pain when the injury is probed. [1]

Sensation is checked to look for nerve damage, and capillary refill for blood circulation damage. The hand is also checked for injuries to the soft tissues, like sprains and tendon tears, and for dislocations to the joints, because these may have been caused at the same time. [1]

Complications

Some finger fractures are severe enough to need surgery. In these severe cases, complications often occur, but most eventually heal functionally. Rarely, there are long-term complications, including decreased range of motion and deformity. [1]

A break that affects the joint surface may be displaced so that there is a step in the joint surface, which should be smooth. This will hinder motion and risks post-traumatic osteoarthritis, so it is usually reduced (put back in place) surgically. If the fracture is unstable (won't stay reduced), or a joint is dislocated or partially dislocated, hand surgeons agree it should be surgically repaired. Open fractures, in which the skin is broken, also increase the risk of infection and complications, especially if the wound is dirty or parts have to be removed. [1] Open fractures are usually operated on. [1]

A Busch fracture is a specific type of finger fracture where the base of a distal phalanx is affected. [5] Without adequate treatment, it can become a mallet finger.

Treatment

Broken fingers are treated in emergency if the broken finger is blue or numb, if the fracture is displaced (the finger is at an angle to where it should be), or if bone is visible in or through the wound. [6]

Extraction

Removing a ring Removal of ring from digit.jpg
Removing a ring

If a broken finger is trapped in an object, it must be freed [7] in a way that avoids further injury. Relaxation, elevation, icing, and lubrication (e.g. soapy water or oil) may suffice. If not, removal by other methods[ clarification needed ] can be done by a doctor; if the object is not portable, it is often done by paramedics or the fire department. [8]

As with other hand injures, any rings or bracelets are removed immediately, before the injury starts to swell. [7] Pulling rings off forcefully may worsen the swelling. Relaxation, elevation, icing, lubrication, and rotating the ring as if unscrewing it may help. If these methods don't work, it may be possible to remove the ring by temporarily wrapping the finger with a slick string (something like dental floss), passing the inner end of the thread under the ring, and then unwrapping it, pushing the ring ahead of the unwrapping string. Failing that, a doctor may remove it by other methods. [9]

Splinting

Buddy-taped fingers:
the broken finger is taped to the next unbroken finger,
with padding, so that it splints it and reduces pain.

A broken finger may or may not require surgery. In simple cases, the bone may be put back in place and the finger may then be put in a splint, or strapped to another finger ("buddy taping"). [3]

If the wrap that splints the finger is too tight, there is a risk of compartment syndrome. If the finger is numb, tingling, more painful, more swollen, or if the skin below the wrap is cool to the touch, the wrap may need loosening. [7]

The splint needs to be kept dry and may interfere with daily tasks, which will need to be done by someone else. [10]

Re-alignment

Many finger fractures are not displaced. Simple displaced fractures may be re-aligned (reduced) with a local anesthetic. [6]

Surgery may be needed for an unstable fracture (one that won't stay in the right place once reduced), [3] a finger broken in multiple places, [6] a fracture that extends into the joint between the broken bone and another bone, and a fracture with damaged tendon function [3] or damaged nerves. [6]

Pain reduction

Rest, ice, and elevation can be used to reduce pain. Icing is done for 15 to 20 minutes every 2 to 3 hours, [6] or 10–20 minutes every 1–2 hours. [10] Ice isn't placed directly on the skin, but wrapped first, [6] [10] in thin cloth [10] such as a teatowel. [6] Icing is done while awake, for the first three days or until the swelling goes down. [10] Elevation can be done by resting the hand upon a cushion or pillow, [6] and trying to keep it above the heart as much as reasonably possible. [10] An over-the-counter painkiller like paracetamol or ibuprofen can also be used, but ibuprofen should not be taken before a doctor has diagnosed the fracture. [6] [ why? ]


Prognosis

Broken fingers and thumbs usually heal in 2–8 weeks, with 3–4 months for full strength. [6] Fingers mostly heal well in 3–4 weeks. Eating healthily and not smoking can speed healing. Pain should steadily decrease, with improvements starting within a few days of the injury. [10]

If it does not steadily improve, or if tingling, weakness, numbness, or signs of infection appear, it needs further treatment; see complications, above. [10]

Epidemiology

Broken fingers affect 0.012% of people per year in the United States. Finger fractures are common in children and old adults, but less common in the 45 to 85 age range. More male children break their fingers; in adults, only slightly more males. Wealthier people are less likely to break their fingers. [1]

The proximal (wristwards) finger bones are those most likely to be broken, and the smaller fingers are more likely to be broken than the index finger and thumb. [1]

Prevention

Prevention includes using protective equipment, avoiding unsafe use of tools and machinery, safety closers to avoid children's fingers being caught in slammed doors, and fall prevention. In sports, prevention includes gloves and avoiding high-hand-risk situations. [1]

See also

Related Research Articles

<span class="mw-page-title-main">Polydactyly</span> Physical anomaly involving extra fingers or toes

Polydactyly or polydactylism, also known as hyperdactyly, is an anomaly in humans and animals resulting in supernumerary fingers and/or toes. Polydactyly is the opposite of oligodactyly.

<span class="mw-page-title-main">Toe</span> Digit of a foot

Toes are the digits of the foot of a tetrapod. Animal species such as cats that walk on their toes are described as being digitigrade. Humans, and other animals that walk on the soles of their feet, are described as being plantigrade; unguligrade animals are those that walk on hooves at the tips of their toes.

<span class="mw-page-title-main">Wrist drop</span> Medical condition

Wrist drop is a medical condition in which the wrist and the fingers cannot extend at the metacarpophalangeal joints. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. As a result, the extensor muscles in the posterior compartment remain paralyzed.

<span class="mw-page-title-main">Sprain</span> Damage to one or more ligaments in a joint

A sprain is a soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers made of collagen that connect two or more bones to form a joint and are important for joint stability and proprioception, which is the body's sense of limb position and movement. Sprains may be mild, moderate, or severe, with the latter two classes involving some degree of tearing of the ligament. Sprains can occur at any joint but most commonly occur in the ankle, knee, or wrist. An equivalent injury to a muscle or tendon is known as a strain.

<span class="mw-page-title-main">Bone fracture</span> Physical damage to the continuity of a bone

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

<span class="mw-page-title-main">Joint dislocation</span> Medical injury

A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. A partial dislocation is referred to as a subluxation. Dislocations are often caused by sudden trauma on the joint like an impact or fall. A joint dislocation can cause damage to the surrounding ligaments, tendons, muscles, and nerves. Dislocations can occur in any major joint or minor joint. The most common joint dislocation is a shoulder dislocation.

<span class="mw-page-title-main">Distal radius fracture</span> Fracture of the radius bone near the wrist

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.

<span class="mw-page-title-main">Boxer's fracture</span> Break of the 5th metacarpal bones of the hand near the knuckle

A boxer's fracture is the break of the 5th metacarpal bones of the hand near the knuckle. Occasionally it is used to refer to fractures of the 4th metacarpal as well. Symptoms include pain and a depressed knuckle.

Splints is an ailment of the horse or pony, characterized by a hard, bony swelling, usually on the inside of a front leg, lying between the splint and cannon bone or on the splint bone itself. It may be "hot," meaning that it occurred recently and is still painful; or "cold," meaning that the splint has completely recovered and there is no longer any swelling or pain associated with it. Bucked shins are sometimes called 'shin splints,' which involve small stress fractures of the dorsal cannon bone, often seen in race training, and discussed elsewhere.

A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod(s) to mimic normal bone stability and limb length, and a mechanical device to apply traction to the limb.

<span class="mw-page-title-main">Mallet finger</span> Type of fracture

A mallet finger, also known as hammer finger or PLF finger or Hannan finger, is an extensor tendon injury at the farthest away finger joint. This results in the inability to extend the finger tip without pushing it. There is generally pain and bruising at the back side of the farthest away finger joint.

<span class="mw-page-title-main">Ulnar collateral ligament injury of the thumb</span> Medical condition

Gamekeeper's thumb is a type of injury to the ulnar collateral ligament (UCL) of the thumb. The UCL may be merely stretched, or it may be torn from its insertion site into the proximal phalanx of the thumb; in approximately 90% of cases part of the bone is actually avulsed from the joint. This condition is commonly observed among gamekeepers and Scottish fowl hunters, as well as athletes. It also occurs among people who sustain a fall onto an outstretched hand while holding a rod, frequently skiers grasping ski poles.

<span class="mw-page-title-main">Jammed finger</span> Medical condition

Jammed finger is a colloquialism referring to a variety of injuries to the joints of the fingers, resulting from axial loading beyond that which the ligaments can withstand. Common parts of the finger susceptible to this type of injury are ligaments, joints, and bones. The severity of the damage to the finger increases with the magnitude of the force exerted by the external object on the fingertip. Toes may become jammed as well, with similar results.

<span class="mw-page-title-main">Bennett's fracture</span> Medical condition

Bennett fracture is a type of partial broken finger involving the base of the thumb, and extends into the carpometacarpal (CMC) joint.

<span class="mw-page-title-main">Hand</span> Extremity at the end of an arm or forelimb

A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala are often described as having "hands" instead of paws on their front limbs. The raccoon is usually described as having "hands" though opposable thumbs are lacking.

The hand is a very complex organ with multiple joints, different types of ligament, tendons and nerves. Hand disease injuries are common in society and can result from excessive use, degenerative disorders or trauma.

Jersey finger, also known as rugby finger, is a finger-related tendon injury that is common in sport and can result in permanent loss of flexion of the end of the finger if not surgically repaired. The injury is common when one player grabs another's jersey with the tips of one or more fingers while that player is pulling or running away. It is the most common closed flexor tendon injury and occurs in the ring finger in 75% of cases.

<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

Theropod paleopathology is the study of injury and disease in theropod dinosaurs. In 2001, Ralph E. Molnar published a survey of pathologies in theropod dinosaur bone that uncovered pathological features in 21 genera from 10 theropod families. Pathologies have been seen on most theropod body parts, with the most common sites of preserved injury and disease being the ribs and tail vertebrae. The least common sites of preserved pathology are the weight-bearing bones like the tibia, femur and sacrum. Most pathologies preserved in theropod fossils are the remains of injuries, but infections and congenital deformities have also been documented. Pathologies are less frequently documented in small theropods, although this may simply be because the larger bones of correspondingly larger animals would be more likely to fossilize in the first place.

<span class="mw-page-title-main">Broken toe</span> Medical condition

A broken toe is a type of bone fracture. Symptoms include pain when the toe is touched near the break point, or compressed along its length. There may be bruising, swelling, stiffness, or displacement of the broken bone ends from their normal position.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 McDaniel, Dalton J.; Rehman, Uzma H. (November 2, 2021). "Phalanx Fractures of the Hand". StatPearls. StatPearls Publishing. PMID   32491557 via PubMed.
  2. 1 2 3 4 5 "Finger Fractures - OrthoInfo - AAOS". www.orthoinfo.org.
  3. 1 2 3 4 Oetgen, Matthew E.; Dodds, Seth D. (December 11, 2007). "Non-operative treatment of common finger injuries". Current Reviews in Musculoskeletal Medicine. 1 (2): 97–102. doi:10.1007/s12178-007-9014-z. PMC   2684218 . PMID   19468880.
  4. Meinberg, Eg; Agel, J; Roberts, Cs; Karam, Md; Kellam, Jf (January 2018). "Fracture and Dislocation Classification Compendium—2018" (PDF). Journal of Orthopaedic Trauma. 32 (1): S1–S10. doi:10.1097/BOT.0000000000001063. PMID   29256945. S2CID   39138324., page 87 of PDF fulltext
  5. Giovanni De Bastiani; Alan G. Apley; Anthony A.J. Goldberg (6 December 2012). Orthofix External Fixation in Trauma and Orthopaedics. Springer Science & Business Media. pp. 883–. ISBN   978-1-4471-0691-3.
  6. 1 2 3 4 5 6 7 8 9 10 "Broken finger or thumb". nhs.uk. October 17, 2017.
  7. 1 2 3 "Finger, Hand, and Wrist Injuries". HealthLink BC. Britich Columbia Ministry of Health. Retrieved November 13, 2021.
  8. "Trapped Finger, Toe, or Limb". HealthLink BC. Retrieved 13 November 2021.
  9. "Removing a Ring From a Finger or Toe". HealthLink BC. Archived from the original on November 13, 2021. Retrieved November 13, 2021.
  10. 1 2 3 4 5 6 7 8 "Finger Fracture: Care Instructions". myhealth.alberta.ca. Retrieved 14 November 2021.