Broken Finger

Picture of a Subungual Hematoma

The main symptoms of a broken finger are pain immediately after the trauma, and sometimes a deformed finger.

1. A true fracture usually will be painful, but a broken finger may still have some range of motion and dull pain, and the individual may still be able to move it. Depending on the fracture stability, some fractures may be more painful than others may.
2. Usually within 5-10 minutes, swelling and bruising of the finger will occur and the finger will stiffen. Swelling may affect the adjacent fingers as well.
3. Numbness of the finger may occur either from the trauma of the injury itself or because swelling compresses the nerves in the fingers.
4. Fractures to the finger tip (distal phalanx) are common from smashing injuries to the fingernail. The symptoms of this type of injury may be swelling and bruising to the finger pad and purple-colored blood underneath the fingernail (subungual hematoma).
5. If the trauma is severe, broken bones may be exposed (called a compound fracture).

Bones of the Hand

Fingers are easily injured, and broken fingers are some of the most common traumatic injuries seen in an emergency room. Fractures of the finger bones (phalanxes) and the bones in the palm (metacarpal bones) are the most common fractures, accounting for 10% of all fractures. Because fingers are used for many everyday activities, they are at higher risk than other parts of the body for traumatic injuries, including sports injuries, workplace injuries, and other accidents.

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: 1) wrist, 2) palm, and 3) fingers.

1. The wrist has eight bones, which move together to allow the vast ranges of motion of the wrist.
2. The palm or mid-hand is comprised 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 injury, or most commonly, a punching injury.
3. 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 phalanxes (bones). 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 named according to their relationship to the palm. The first bone, closest to the palm, is the proximal phalanx; the second bone is the middle phalanx; the smallest and farthest from the hand is the distal phalanx. The thumb does not have a middle phalanx.
• The knuckles are joints formed by the bones of the fingers and are commonly injured or dislocated with trauma to the hand.
  • The first and largest knuckle is the junction between the hand and the fingers - the metacarpophalangeal joint (MCP). This joint commonly is injured in closed-fist activities and is commonly known as a boxer's fracture.
  • The next knuckle out toward the fingernail is the proximal interphalangeal joint (PIP). This joint may be dislocated in sporting events when a ball or object directly strikes the finger.
  • The farthest joint of the finger is the distal interphalangeal joint (DIP). Injuries to this joint usually involve a fracture or torn tendon (avulsion) injury.

Traumatic injury is the main cause of broken fingers. Most commonly, traumatic injury to the finger occurs from playing sports, workplace injuries, falls, or other accidents.

• After an injury, if pain or swelling limits the motion or use of the fingers, or if the finger becomes numb, seek medical care.
• If the injury to the finger includes a laceration, crushed tissue, or exposure to the bone, the individual should go to an emergency department for immediate medical care.
• Some fractures of the fingers may be subtle and the pain may be tolerable, so if a person suspects that they may have a finger fracture, seek medical attention.

X-ray is the primary tool used to diagnose a broken finger. The doctor will need an X-ray to evaluate the position of the broken finger bones.

With more complex injuries, the doctor may seek the advice of an orthopedic (bone and joint specialist) or hand surgeon (an orthopedic surgeon or plastic surgeon with post-residency, fellowship level training in hand surgery).

Broken fingers should be treated by medical professionals; however, a person can minimize some pain and stabilize the injury on the way to seeking medical treatment.

• To reduce swelling and bruising, apply ice to the injured finger on the way to an emergency department. Do not apply ice directly to the skin; put a towel between the ice and the finger.
• Make a splint to immobilize the finger. A Popsicle stick or pen may be placed next to the broken finger, and then wrap something around the stick and the finger to hold it in place. Wrap loosely - if the finger is wrapped too tightly it can cause additional swelling and may cut off circulation to the injured digit.
• Keep the injured finger elevated.
• Remove all rings or jewelry from the affected hand before swelling occurs.

Medical treatment

The doctor will assess the stability of the broken finger. The treatment for a broken finger depends on the type of fracture and the particular bone in the finger that is injured.

If the fracture is stable (not likely to worsen or cause complications with the movement of the finger), 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 of limiting the use of the finger.

If the fracture is unstable, the injured finger will need to be immobilized. A splint may be applied after reduction (re-aligning of the fractured fragments). If this does not maintain enough stability, a surgical procedure may be needed.

A surgeon has many different techniques for surgical immobilization, ranging from pinning the fracture with small wires to procedures with plates and screws.

The patient will most likely leave the hospital in some type of immobilizing splint or dressing. Keep the dressing clean, dry, and elevated. It is best not to use the involved hand until a hand specialist is consulted (about one week after the injury) for another X-ray to evaluate the position of the fracture fragments. If the finger is not aligned correctly, it may affect the healing of the finger and leave a permanent disability.

After reduction, immobilization, and four to six weeks of healing, the prognosis for healing is excellent for a broken finger.

• Joint stiffness is the most common problem encountered after treatment of fractures in the fingers due to scar tissue formation and the long immobilization period. Physical therapy may be prescribed (preferably by a hand therapist) to regain range of motion.
• Rotation can occur when one of the bones in the finger rotates abnormally during the healing process. This can cause deformity and decreased ability to use the injured finger when grasping.
• Nonunion is a complication of some fractures when the two ends of the bone do not heal together properly, leaving the fractured area unstable.
• If the skin is injured or if surgery is necessary to fix the fractured bone, the infection may result.

The best medicine for the prevention of finger fractures is safety. Most fingers are broken from machines, self-inflicted trauma (punching something), or sporting injuries. Always use safety equipment when doing activities that may injure the hands. Injuries should be evaluated as soon as possible.