Definition and Facts about Broken Finger
- Fingers are easily injured from everyday activities, and finger injuries are some of the most common traumatic injuries seen in an emergency room. Injuries may range from simple bruises or contusions to broken bones and dislocations of the joints. Understanding the basic anatomy of the hand and fingers is useful in understanding different types of finger injuries, broken fingers, and how some treatments differ from others.
- The hand is divided into three sections: wrist, palm, and fingers. There are eight bones in the wrist, which move together to allow the vast ranges of motion of the wrist. The palm, or mid-hand, is made up of the metacarpal bones. The metacarpal bones have muscular attachments and bridge the wrist to the individual fingers. These bones frequently are injured with direct trauma such as a crush from an object or most commonly from a punching injury.
- The fingers are the most frequently injured part of the hand. Fingers are constructed of ligaments (strong supportive tissue connecting bone to bone), tendons (attachment tissue from muscle to bone), and three bones called phalanges. There are no muscles in the fingers. Fingers move by the pull of forearm muscles on the tendons.
- The three bones in each finger are arranged in the same manner. The finger bones are named in their relation to the hand. The first bone is the proximal phalanx. The second bone is the middle phalanx. The smallest and farthest from the hand is the distal phalanx. The thumb is the shortest finger and does not have the middle phalanx.
- Knuckles on the back of the hand are joints formed by the bones of the fingers. They are commonly injured or dislocated with trauma to the hand. Each joint has a specific name depending on its location and the bones involved.
- The first and largest knuckle is the junction between the palmar bones and the fingers. Medically, it is the joint of the metacarpals and phalanges or the metacarpophalangeal joint (MCP). This joint commonly is injured in closed fist activities, for example, punching something. The common term for a fracture of this area is called a Boxer's fracture.
- The next knuckle out toward the fingertip is the joint closest to the hand and between the finger bones. It is termed the proximal inter-phalangeal joint (PIP). This joint may be dislocated in sporting events when a ball or object directly strikes the finger.
- The farthest point of the finger is the distal inter-phalangeal joint (DIP). Injuries to this joint usually involve a fracture (a break) or tendon tearing (avulsion) injury.
What Are the Signs and Symptoms of a Broken Finger?
Broken fingers frequently cause immediate pain after trauma, sometimes due to a deformed finger either at a joint (commonly a dislocation) or as an actual break through the bone as a fracture. If there is no deformity, a sharp pain is felt very specifically at the injury site.
- A true fracture usually will be painful, but do not be fooled by a finger that has some range of motion as the finger may be able to bend. Depending on their stability, some fractures may hurt more than others.
- As time goes on, usually within the next 5-10 minutes, swelling and bruising of the finger will occur and the finger will become stiff to move. Swelling is not as specific as pain and may affect the adjacent fingers as well.
- If the fracture is severe, bruising from released blood may be seen immediately.
- Finally, if the swelling is excessive, numbness of the finger may occur because the nerves in the fingers are compressed.
Broken Finger Pictures
Broken finger. X-ray of a severe fracture of the proximal phalanx of the small finger. This bone is broken in many small fragments and very unstable. This injury occurred in an automobile accident, but injuries like this also can be seen in any traumatic incident. Because it was unstable, surgery was needed. In this type of injury, the surgeon may use either pins or plates and screws for repair. The pins would stay in for about 4-6 weeks, and plates and screws would be removed only if bothersome. Click to view larger image. Broken finger. This X-ray shows an oblique (diagonal) fracture through the proximal phalanx of the ring finger. Notice how the fracture tends to slip or shorten (arrow). Not only does this fracture shorten, but rotational deformities are also seen. Usually it is not stable enough for just buddy taping, and surgery may be needed. Click to view larger image. Broken finger. This X-ray is taken in the operating room after pinning of a fracture similar to the one in picture 2. The X-ray shows how the multiple small pins hold the fracture in anatomic alignment and the shortening is gone. This will maintain stability until the fracture is healed. The pins may be removed in 4-6 weeks. Click to view larger image. Broken finger. A typical fracture at the end of the small finger metacarpal is shown in this X-ray. The fragment is most always flexed toward the palm as seen in this X-ray. Most typically this fracture is caused by a closed fist striking an object. This commonly is called a boxer's (or brawler's) fracture. Treatment of this fracture usually is conservative casting. Don't be alarmed by the angulation of the bone. It is usually only cosmetic, and hand function should be normal after the bone heals. Click to view larger image. Broken finger. This X-ray illustrates a common fracture of the distal phalanx. It is an injury where the distal phalanx is forced toward the palm and resisted by the pull of the extensor tendon. This is very common in sporting events in which a ball strikes the end of the finger (often called mallet finger). These injuries are either bony (as seen) or involve ligaments. Treatment is splinting or surgical pinning of the distal phalanx. This injury may take a long time to heal and must be watched closely. Despite every effort to heal, a residual lag may continue after treatment. This usually is cosmetic only and does not affect grip strength. Click to view larger image. Broken finger. This is an X-ray of an oblique (diagonal) fracture of a metacarpal. These injuries occur from a twisting or splinting to the hand. They are common to machining and workplace injuries as well as direct trauma. There are many different muscles and tendons that may accentuate this fracture causing shortening or angulation toward the palm. Treatment may consist of either casting with close observation or a surgical procedure for stability of the fracture. This would depend on the severity of the fracture seen on the X-ray. Click to view larger image.
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When to Seek Medical Care for a Broken Finger
The doctor will need an X-ray to evaluate the position of the broken finger bones. An urgent care facility or a hospital's emergency department usually have the needed supplies for X-ray evaluation and splinting.
Rarely, a surgical procedure is needed to stabilize the fracture. Complications of this may include loss of full motion of the finger or infection. Signs of a finger infection are fever, increasing redness, swelling, severe pain of the finger, or even discharge of pus and a foul smell from the surgery site. If these symptoms occur, go to the emergency department or your surgeon immediately to be evaluated.
How Is a Broken Finger Diagnosed?
The mainstay of diagnosing finger fractures is an X-ray. Temporary splinting, ice, and pain control are helpful supportive treatments. The type of fracture will determine the treatment. Each fracture pattern has specific characteristics that need to be addressed.
- If there is a simple fracture, the doctor will splint the injured finger. The whole hand may be put at rest and splinted for comfort.
- With more complex injuries, the doctor may seek the advice of an orthopedic (bone and joint specialist) or hand surgeon (who has specialized training in hand surgery).
How to Buddy Tape (Splint) and Treat a Broken Finger at Home
- Make a splint (immobilize the finger: a popsicle stick or pen may be placed next to the finger with something wrapped around the stick and the finger).
- Apply ice to the injured finger on the way to the emergency department. Do not apply ice directly to the skin. Put a towel between the ice and the finger.
When Does a Broken Finger Need Medical Treatment?
Treatment of broken fingers depends on the type of fracture and particular bone in the finger that is injured. The emergency doctor or an orthopedic surgeon will assess the stability of the broken finger.
- If the fracture is stable, treatment may be as simple as buddy taping (splinting one finger to another by taping them together) for about four weeks followed by an additional two weeks with no strenuous exercise.
- If the fracture is unstable, the injured finger will need to be immobilized. Immobilization is done in several different ways:
- Most simply, a splint may be applied after reduction (re-aligning of the fracture fragments). If this does not maintain enough stability, a surgical procedure may be needed.
When Does a Broken Finger Need Surgery?
If surgery is performed to fix the fractured finger, you will most likely leave the hospital in some type of splint or dressing. It is very important not to disturb the splint. It is holding the fractured finger in the correct position for healing. Keep the dressing clean, dry, and elevated in order to decrease the swelling.
Activity may aggravate the injury and cause increasing pain, so it is best not to use the involved hand until the follow-up appointment with the hand specialist.
A specialist may want to see the patient about one week after the injury occurred for another x-ray to evaluate the position of the fracture fragments. It is extremely important to make this appointment. If the finger is not aligned correctly, it may affect the healing of the finger and leave permanent disability.
How Long Does a Broken Finger Take to Heal?
- After reduction, immobilization, and four to six weeks of healing, the prognosis for the bones coming together and healing properly is excellent for a broken finger.
- The most common problem encountered after treatment of fractures in the fingers is joint stiffness. By immobilizing the fingers, the capsule and surrounding tissue from scar tissue around the joint. It becomes a race to heal the bone before the joint becomes too stiff and a decrease in motion occurs.
- Many people may require physical therapy (preferably with a hand therapist) for a range of motion exercises. Stiffness and swelling are of great concern and may be long-term reminders of the injury. It is important to continue therapy because the range of motion may continue to improve for up to a year.
How Can a Broken Finger be Prevented?
The best medicine for prevention of finger fractures is safety. Most fingers are broken from machines, falls or sporting injuries. Always use safety equipment when doing activities that may injure the hands. Despite all efforts and precautions, injuries do occur and should be evaluated as soon possible.