Finger

• Finger Fracture

• Mallet Finger

• Fingertip Injury

A fractured (broken) finger is usually the result of a trauma, such as a fall on an outstretched hand, a punch, or slamming the finger in a door.

There are 14 bones in total in the fingers (phalanges) of each hand, each of which is susceptible to fracture.

A broken finger typically results in pain, swelling, tenderness and bruising. Moving the injured finger may be difficult, and it may look deformed. These symptoms usually develop immediately at the time of the injury.

Signs of a Finger Fracture

It is sometimes difficult to determine whether a finger is fractured because similar symptoms may occur from other injuries. The following symptoms at the site are possible indicators of a broken bone in the finger:

• Severe, persistent pain, especially when touched
• Swelling
• Difficulty bending the joints
• Deformity of the finger

All of these symptoms may be the result of other problems, including infection, dislocation, or tendon injury. It is important to consult a physician for a definitive diagnosis because the treatments for these conditions vary and improper treatment may lead to permanent disability.

Diagnosis of a Finger Fracture

X-rays are necessary to determine not only whether there is a finger fracture, but the nature and severity of that fracture. The doctor must determine whether the fracture involves a joint, and, if so, whether the joint surfaces are in alignment. The X-ray will also allow the doctor to determine whether the fracture is unstable, that is, likely to slip out of its correct position. Finally, the doctor has to assess any possible deformities of the finger, such as inappropriate rotation or shortening. All of this information is important in determining how the fracture is to be treated.

Treatment of a Finger Fracture

In spite of the fact that a finger fracture appears to be, and often is, a minor injury, in some cases, improper treatment can lead to long-term dysfunction of the hand. Treatment of a finger fracture is designed not only to alleviate symptoms, but to ensure that permanent damage does not result.

In most situations, a finger fracture can be treated nonsurgically. Typically, a splint or small cast is used to keep the finger in a straightened position while it heals. Sometimes, with more minor injuries, it is possible to use an adjacent finger as a splint, a process known as "buddy taping." Healing of a fractured finger usually takes 3 to 4 weeks.

When a broken finger is out of its normal position (dislocated), the deformity must be corrected to prevent permanent disfigurement or dysfunction. This procedure is normally performed under local anesthesia. Once the area has been completely numbed, the doctor can manipulate the finger to correct its position. If the deformity is severe, however, surgery may be necessary. During the surgical procedure, the broken bones are realigned, fixed in place with surgical hardware. After surgery, a cast is used to keep the bones immobilized as they heal.

Mallet finger, also known as baseball finger, involves a tear in the finger's extensor tendon, the tendon that allows the finger to straighten. A finger with this injury droops at its tip.

Whenever a fingertip is jammed or forcefully bent down during any activity, the extensor tendon can tear. Because this injury is often caused by a direct blow to the finger from a ball or similar object, baseball and basketball players are especially susceptible.

At times, during a mallet finger injury, a piece of bone is torn away with the tendon. This is known as an avulsion fracture.

Symptoms of a Mallet Finger

The symptoms of a mallet finger are normally quite obvious. Not only does the patient experience pain, swelling and bruising soon after injury, but the fingertip droops noticeably. Occasionally, blood accumulates beneath the nail or the nail becomes detached from the nail bed.

Diagnosis of a Mallet Finger

While a mallet finger is typically easy to diagnose upon physical examination, in most situations, the doctor has X-rays taken to rule out other injuries, such as a bone fracture or joint misalignment.

Recovery from a Mallet Finger

For most patients, wearing the splint is the only necessary treatment for a mallet finger. During the healing process, the splint may be removed for cleaning, but patients should take care to keep the finger straight while the splint is off.

Patients are able to return to most normal activities during recovery, as long as the splint remains in place. Even with appropriate treatment and care, some patients may not regain full extension of the fingertip, but will have full, or almost full, finger function.

Treatment of a Mallet Finger

First-aid treatment for a mallet finger injury includes the application of ice to reduce swelling, the elevation of the finger above the level of the heart, and the administration of over-the-counter painkillers or anti-inflammatories. Prompt medical consultation is needed to rule out more serious damage, particularly if blood has collected under the nail or the nail has become detached from its bed since this may indicate the presence of a compound (open) fracture.

Nonsurgical Treatment
Assuming the mallet finger does not involve a bone fracture, a splint is applied to keep the finger in full extension as it heals. The doctor will assess the damage and recommend the length of time the splint will need to be worn accordingly, usually between 4 and 8 weeks. At times, the doctor will recommend wearing the splint full-time for several weeks and then wearing it only during sleep.

Although some patients may be tempted to wear the splint less frequently than advised, care should be taken to follow the doctor's directions to ensure that treatment is as effective as possible. This is especially important when the injury occurs in a child to avoid stunting or deformity as the child grows. Even in adult patients, ignoring the physician's advice may result in longer, or less complete, recovery.

Surgical Treatment
When X-rays detect a fracture, surgical intervention may be necessary, but usually only if :

• Large bone fragments are present
• There is joint misalignment
• There is severe deformity
• There is severe dysfunction
• There is severe tendon damage

In such cases, surgical hardware may be used in the repair in order to hold the bones in the proper position as they heal. In some cases, the joint may be fused, or the tendon may be repaired by stretching or through the use of tendon grafts.

A fingertip injury is a fairly common type of hand injury, one often caused by an accident, such as slamming a finger in a door, that occurs during everyday activities. A fingertip injury can involve the skin, bone, nail, nail bed or pulp, which is the soft padding on the back of the fingertip. A fingertip can be cut, crushed, torn or cut off completely. Because it contains more nerve endings than many other parts of the body, a fingertip is extremely sensitive, making injury to it particularly painful.

An serious injury to the fingertip should be evaluated by a physician in order to ensure that the function of the finger, as well as that of the hand itself, is not permanently affected. Before it is evaluated by a physician, an injured fingertip should be iced and elevated to keep swelling and bleeding to a minimum, and a sterile bandage should be applied.

In addition to those treatments, if a finger has been cut off, the amputated piece should be cleaned with a sterile solution, wrapped in gauze, and put in a watertight bag that is then placed on ice.

Examination by a physician includes a thorough cleaning of the wounded area; an injection of anesthetic is often given to relieve pain. The physician checks to see if bone is exposed, tissue is missing, and/or the nail is injured. An antibiotic may be prescribed and/or a tetanus shot given. Most fingertip injuries can be treated by suturing the wound. It takes several weeks for a finger to fully heal, during which time it is wrapped in a dressing or supported in a splint. Whether or not a cut-off fingertip is reattached during replantation surgery, which is extremely complex, is subject to many variables.