Hand Fractures

What are hand fractures?

Fractures are cracks or breaks in bones. Children and teens may break their finger or thumb bones (phalanges, fah-LAN-jeez), their wrist bones (carpals) or the long bones between their fingers and their wrist (metacarpals).

Most hand fractures happen when:

• A child falls on their hand.
• Their hand gets twisted, bent or smashed.
• The child hits (or is hit by) something hard.
• In toddlers, breaks often happen when the tip of their finger gets caught in a door.
• Older children tend to get breaks during sports or other active play.

An injury that breaks a bone may also damage a child’s growth plates or soft tissues that are near the bone or connect to the bone, such as skin, ligaments or tendons. Damage to growth plates or soft tissues may affect the way doctors treat your child’s fracture.

Types of fractures

There are several types of fractures:

• Simple fractures are breaks or cracks in the bone that do not break through the skin.
• Open fractures are breaks in which the bone sticks through the skin.
• Traumatic fractures occur due to injury, such as falling while running, biking or riding a skateboard. The bone gets more force than it is able to handle, and it breaks. Most fractures are traumatic.
• Stress fractures can happen when a child or teen repeats the same position or motion over and over for long periods of time. Stress fractures are not common.
• Pathologic fractures occur because the bone is weaker than normal. This is usually due to holes in the bone (bone cysts) or certain bone conditions, such as brittle bone disorder (osteogenesis imperfecta), in which bones break easily. This is not a common cause of fractures.

Hand Fractures in Children and Teens

Fractures are very common in children and teens. About half of all boys and a quarter of all girls break a bone sometime before adulthood.

Children are flexible, so their bones may bend after a break. They may straighten out as they heal. This process is called remodeling.

Because of remodeling, a young person’s broken bone will heal better and with less treatment than a similar break in an adult. But some fractures that look simple to treat can cause serious problems for children or teens and affect the bone’s ability to grow.

Growth plates

In every child’s and teen’s bones, growth occurs at specific points called growth centers or growth plates. Often, these points are near the ends of the bone.

If the growth plate is damaged by a fracture or another injury, the bone may stop growing. This serious problem is called a growth arrest. Growth arrest can permanently stop a bone’s development and change how it functions. If only part of the growth plate is damaged and stops working, the bone may grow in an uneven way.

Hand Fractures at Seattle Children’s

At Seattle Children’s, we understand children’s and teens’ growing bones. We have the knowledge and experience to provide expert fracture care, including surgical treatment of the most complex cases.

We treat about 2,000 children and teens with fractures each year. In the summer, when children play the hardest, we see many fractures on our busiest days. Many of the patients we treat are referred to us from other doctors and hospitals throughout the Pacific Northwest.

Learn more about our Fracture Program, which handles fractures and growth-plate injuries, and our Hand and Upper Extremity Program, which focuses on hand and arm conditions, including fractures.

• 
  
  The compassionate experts you need are here
  

  Our fracture team is led by surgeons who specialize in the treatment of children’s bones, muscles and joints (pediatric orthopedists). The team also includes physician assistants, orthopedic technologists, nurses and pediatricians trained in sports medicine. Their goal is to get your child back to their usual activities as quickly as possible. To restore or improve your child’s health, function and quality of life, we often use nonsurgical methods (like splints or casts), recommending surgery only when we believe it will give your child the best results.

  Many of our pediatric orthopedic surgeons have expanded fellowship training.

  We have the largest group of board-certified pediatric radiologists in the Northwest. Our radiologists have special expertise using ultrasound to look for bone and joint changes so we can work with your child to help prevent future problems. If your child needs imaging that uses radiation, we use the lowest amount possible to produce the best image. We also have a 3D low-dose radiation X-ray machine, called the EOS, for safer full-body 3D images.

• 
  
  Treating the whole child
  

  We see your child as a whole person. Infants, children and teens are still developing, so they may need different care than adults do, like treatment that takes their growth plates into account. Here, your child’s team has special training in the medical, surgical, emotional and social needs of young people.

Symptoms of Hand Fractures

Some signs of broken bones are clear – for example, when the bone breaks through the skin in an open fracture. Other signs that bones may be broken and growth plates injured include:

• Severe pain.
• Swelling, bruising or bleeding.
• Bone or joint that looks out of place or the wrong shape.
• Weakness, numbness or tingling.
• Trouble moving the part of the body that is broken.
• When your child or teen breaks a bone, they will have pain at the site of the break. It will be hard for them to move the body part that is broken. This pain and loss of movement are your cues to take them to the doctor or the emergency room.

Diagnosing Hand Fractures

First, we examine your child. During the exam, the doctor checks how the bones line up when your child moves their hand, if they can, and when the doctor tries to move it. The doctor also looks for related injuries, like damage to the fingernail, tissue under the nail (nail bed), ligaments, tendons or joints.

If 1 or more bones might be fractured, your child will need X-rays. This helps us know how to treat your child. Most likely your child will have X-rays from 3 angles so the doctor can see clearly where the break or breaks are.

Diagnosing complex fractures

Careful diagnosis is important. Simpler breaks can be treated with a splint or a cast. More complex breaks may require surgery. Knowing when a child’s fracture needs surgery requires special education and experience with pediatric trauma.

If the bone is broken at or near a growth plate, the doctor may suspect the growth plate is injured. The growth plate itself can’t be seen on an X-ray, but some signs of damage may show up. Sometimes children need an MRI (magnetic resonance imaging) scan or other scan to check for growth-plate damage.

Treating Hand Fractures

Your child’s treatment will depend on which bone they broke and which type of fracture they have. The finger and thumb bones, the wrist bones (carpals) and the long bones between the fingers and wrist (metacarpals) can break in several ways.

Your child’s doctor will consider many other factors, such as these:

• Whether the broken bone is lined up in a normal way or is out of position (displaced)
• Whether the broken bone is stable or it moves out of place easily
• How old your child is, because their stage of growth may affect how their bone heals

Nonsurgical Treatment Options for Hand Fractures

To get the best results, it’s important not to do more or less than needed. Most children’s hand fractures heal fine with simple methods, like splinting or casting. Some require surgery. Hand fractures can happen and heal differently in children than in adults.

• 
  
  Splinting, buddy taping and casting
  

  If your child’s X-ray shows a fracture but the bone is straight and in a good position, we may give them a splint to keep the bone in place while it heals.

  For some breaks, buddy taping is an option. Buddy taping means taping 2 fingers together to keep broken fingers from moving too much.

  Sometimes a splint or buddy taping is all that your child needs while the bone heals. Based on which bone they broke and how severe the break is, we may need to put a cast on once swelling is under control. We apply casts if we think the bone may not heal well unless it stays in 1 position.

  We also use casts if they can make your child more comfortable by keeping the broken bone still. This reduces the pain that comes if the broken body part is bumped or moved.

• 
  
  Moving the bone back into place (fracture reduction)
  

  If your child’s X-ray shows their fractured bone is at an angle or in a bad position, the doctor will try to move the bone back into place (fracture reduction) before splinting, taping or casting. The doctor may be able to do this just by using their hands to move your child’s finger or hand (closed reduction). Before reduction, we give your child medicine to block feeling around their fracture (anesthesia) or to relax them (sedative).

Surgery for Fractures

If the doctor can’t move the bone back into place just by using their hands (closed reduction), your child may need surgery.

The surgeon will make a small cut (incision) so they can see the fracture and move the bone (open reduction). In some cases, we use pins to keep the bone in place so it can heal correctly. Later we take out these pins at a clinic visit.

Most children with hand fractures do not need surgery. If your child does need an operation, our surgical staff can ensure that they receive the most appropriate surgery for their injury.

Dealing With Growth-Plate Injuries

Most growth-plate injuries will heal without affecting growth. The risk of problems depends on many factors, such as how serious the injury is, how old your child is and which bone they broke.

If your child has or might have a growth-plate injury, the doctor will ask you to watch for signs of growth problems. The doctor will also want your child to come back from time to time in the first 1 to 2 years after the injury. The doctor will examine your child, and your child may have X-rays to check for growth problems. For example, the finger that was broken may not be growing as fast as the other fingers or it may not be growing straight.

Some children who develop growth problems may need surgery to adjust the length of a bone or other care.

Finger Fractures Video | Medical Video Library

The hand is made up of 27 bones that form the wrist, palm, and fingers. Fingers can easily injure from daily activities, and fractures are common injuries that can occur. Injury to the metacarpal bone that connects to the little finger are the most common fractures, accounting for about one-third of all hand fractures. The fracture may be simple or involve a shift in the position of the bone or joint. There are also more severe fractures where the bone is crushed into many pieces.

Causes.

Finger fractures occur most often from high impact trauma to the hand such as with a fall, motor vehicle accident, sports activities, or a fist fight.

Signs and Symptoms.

The common signs of a finger fracture include:

Swelling and bruising around the fracture site

Pain and tenderness

Difficulty with finger movement

Deformity of the finger

Diagnosis.

Finger fractures can be difficult to diagnose as the symptoms are similar to those of bone dislocation or sprain. Your physician diagnoses finger fracture after examining both the injured and uninjured fingers of the hand to see if they are of the same length. A fracture can also be detected when the injured finger overlaps with the others when you make a fist. An X-ray will be ordered to locate the injured area and confirm the diagnosis of a fracture.

Treatment.

The treatment of a finger fracture begins with realigning the finger bone into the correct position usually under local anesthesia without cutting the skin. This is referred to as a closed reduction.

A splint or plaster cast is then wrapped around the finger to support and protect it and keep it in the correct position while it heals. Your doctor may include the adjacent finger within the splint for additional support, a technique called buddy taping.

Surgery.

If the fracture is severe, your surgeon will recommend surgery to repair the finger bones. An incision is made over the site of the fracture. Your surgeon will set the bones in correct alignment with instrumentation such as plates, pins or screws to hold the bones in place. Sometimes the bones may be severely shattered beyond repair. In such cases, your surgeon will use a bone graft to place new bone or bone substitutes into the spaces around the fracture. Once the repair is complete, the incision is closed and the finger is placed in a cast.

Post-op care.

You will be instructed on how to care for your cast. For the first 2-3 days you should elevate the hand to decrease swelling and apply ice over the cast for 20 minutes at a time.

Do not smoke as smoking slows down or prevents bone healing.  If a bone graft was inserted, smoking can cause the graft to fail.

Once the cast is removed, your physical therapist will instruct you on rehabilitation exercises to reduce the stiffness and restore range of motion to the finger.

Risks and complications.

The possible risks and complication associated with finger fracture surgery include:

Pain

Bleeding

Infection

Stiffness

Non-union (bone fails to unite)

Malunion (Deformed union of the fractured bone)

Damage of the surrounding nerves or blood vessels

Fingers are the most common part of the hand that are fractured. Treatment depends on the severity of the fracture and involves surgically or non-surgically realigning the bones, and placing a cast until the bone heals.

Boxer’s Fracture | Cedars-Sinai

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What is a boxer’s fracture?

A boxer’s fracture is a break in
the neck of the 5th metacarpal bone in the hand. It gets its name because the injury
is
common in inexperienced boxers.

The metacarpal bones are the
intermediate bones of the hand found inside the flat part of the hand. They connect
the
bones of the fingers (the phalanges) to the bones of the wrist (the carpals). The
5th
metacarpal is the metacarpal of the 5th (pinky) finger. The neck of the metacarpal
bone
is where the main shaft of the bone starts to widen outwards towards the knuckle.

Boxers are not the only people who can get a boxer’s fracture, but usually the injury
results from direct injury to a clenched fist. The force fractures the neck of the
metacarpal bone below the pinky.

Your healthcare provider will need
to make sure you have a boxer’s fracture and not another type of metacarpal fracture,
like a break at the shaft of the metacarpal or a fracture at the base of the small
finger. These injuries may need different treatments.

Metacarpal bones are some of the
most commonly broken bones in the hands. A large number of these are boxer’s
fractures.

What causes a boxer’s fracture?

Usually, a boxer’s fracture happens when you punch a wall or another solid object
at a high speed. You also might get a boxer’s fracture if you fall hard on your closed
fist. The neck of the metacarpal bone is its weakest point, so it tends to fracture
here.

What are the symptoms of a boxer’s fracture?

Symptoms of a boxer’s fracture can include:

• Painful bruising and swelling of the back and front of the hand
• Pain of the back of the hand in the
  area of the fractured 5th metacarpal
• Bent, claw-like pinky finger that
  looks out of alignment
• Limited range of motion of the hand
  and of the 4th and 5th fingers

Your knuckle may also not have its normal bumpy shape. Your symptoms may vary in severity
depending on the complexity of your fracture. You might have only mild pain, or the
pain might be more severe.

How is a boxer’s fracture diagnosed?

Your healthcare provider will ask
you about your symptoms, how you injured the hand, and your past medical problems.
Your
provider will also examine your hand carefully, checking for pain, strength,
misalignment, range of motion, breaks in the skin, and other problems.

An X-ray of the hand can clearly confirm a boxer’s fracture.

How is a boxer’s fracture treated?

Your treatment depends on how severe the fracture is. Initial treatment might include:

• Washing any cuts in the skin
• Getting a tetanus shot if you have a cut and haven’t had a shot for several years
• Resting your hand for a few days
• Keeping your hand above the level of your heart for a few days
• Icing your injury several times a day
• Taking pain medicine (prescription or over-the-counter)
• Wearing a splint for several weeks

Before your healthcare provider
puts your hand into a splint, they may need to put your bones back into alignment.
Usually, you’ll receive a local anesthetic to keep you from feeling any pain, and
your
provider will move the bones back into place. In some cases, you may need surgery
to get
the bones back into alignment.

You also may need to work with a physical therapist for a while as your fracture heals.
You’ll learn exercises to strengthen the muscles of your hand and keep them from getting
stiff.

If you have an unusually severe
boxer’s fracture, you may need immediate and more complicated surgery. For example,
if
your bone has broken through the skin, or if it has broken in several places, you
will
probably need surgery. You might also need surgery if you have a job or hobby that
needs a lot of fine-motor movement of the hand, like playing the piano.

Even if you don’t need surgery right away, you might need it at some point. If your
hand doesn’t heal as well as expected, surgery might be an option.

What are possible complications of a boxer’s fracture?

An untreated boxer’s fracture can
lead to a decrease in your ability to grip, limited range of motion of the finger,
and
an abnormal looking finger. With treatment, these problems are usually minor, if
they
happen at all.

What can I do to prevent a boxer’s fracture?

Avoid fistfights and punching solid
objects to prevent many cases of boxer’s fracture. If you box, make sure you use the
correct technique and the proper equipment.

How to manage a boxer’s fracture

Your healthcare provider may give
you some instructions about how to manage your boxer’s fracture, such as:

• Keep your bones strong by eating a healthy diet with enough vitamin D, calcium, and
  protein
• Stop smoking to help your fracture
  heal more quickly
• Keep your splint from getting wet

Your hand will be very easy to
injure again for 4 to 6 weeks after your splint is gone. You may need to use a hand
brace if you return to contact sports during this time. Talk with your healthcare
provider about what makes sense for you.

When should I call my healthcare provider?

Call your healthcare provider
if:

• You have numbness or tingling in your fingers
• Your fingers look blue
• You have severe pain or worsening swelling
• Your splint gets damaged or wet and
  you need a new one

Key points about a boxer’s fracture

A boxer’s fracture is a break in
the neck of the 5th metacarpal bone in the hand. It usually happens when you punch
an
object at a high speed.

• Symptoms of a boxer’s fracture include pain and swelling of the hand, limited range
  of motion of the pinky finger, and misalignment of the finger.
• Your healthcare provider can diagnose
  your boxer’s fracture with a health history, physical exam, and X-ray.
• You might need treatment that includes
  simple rest, ice, pain medicine, and splinting.
• You might need surgery for your injury if it is severe.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells
  you.
• At the visit, write down the name of a
  new diagnosis and any new medicines, treatments, or tests. Also write down any new
  instructions your provider gives you.
• Know why a new medicine or treatment
  is prescribed and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how you can contact your provider
  if you have questions.

Medical Reviewer: Thomas N Joseph MD

Medical Reviewer: Raymond Turley Jr PA-C

Medical Reviewer: Stacey Wojcik MBA BSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Fracture of Middle Phalanx of Finger

Fracture of Middle Phalanx of Finger

Overview

Each finger is made up of several bones, and the middle phalanx is the bone located between the first joint and center knuckle. The joints on either side of the middle phalanx allow you to flex and hook your finger, which allows you to handle or manipulate items on a daily basis. Fractures in the middle phalanx are rare, but finger fractures in general are common due to the constant need and use for the finger.

Causes

Since the hands and fingers are a vital part of everyday life, they are subjected to a variety of traumatic injuries. A fractured middle phalanx can occur for these common reasons:

• Jammed finger
• Motor vehicle accidents
• Falls
• Contact sports
• Direct impact to the finger
• Workplace dangers

Symptoms

As with any broken bone, the initial symptom of a middle phalanx fracture is pain. Even with a fracture, you may still be able to bend or move the finger, but pain will intensify if you try to do so. Other symptoms of a fractured finger bone include:

• Swelling
• Bruising
• Stiffening in the finger or joints
• Swelling and pain extends beyond the injured area
• Numbness
• Bruising and swelling underneath the fingernail, as well as the fingertip

Diagnosis

If the skin is not broken, an x-ray is often enough to provide information and imaging to the doctor to diagnose a fracture. Depending on the injury, it is possible the doctor will request additional tests, such as:

Treatment

Should you break your finger, stabilizing the injury as soon as possible is ideal. Ways to stabilize the bone on the way to the doctors is by:

• Applying a bag of ice to the area to reduce swelling
• Use a pen or pencil to place alongside the finger and wrap in gauze or cloth to immobilize the finger

Once you get medical help, the following steps are used to treat the fractured bone:

• Stable — Taping two fingers together to keep them immobile and stable
• Unstable – After anesthesia, the bone will be re-aligned and put into a splint for healing

Surgery

If the bone is shattered or unable to be re-aligned, surgery may be required. Re-aligning the bone and fitting it with a plate, wires and pins will keep the bones in place as it heals. If the bone broke through the skin, additional surgical treatment may be needed to repair any damaged tendons.

Growth Plate Fractures (for Parents)

What Is a Growth Plate?

Growth plates are the areas of active, new bone growth near the ends of bones. They’re made up of cartilage, a rubbery, flexible material (the nose, for instance, is made of cartilage).

When kids are done growing, the growth plates harden into solid bone. This happens in girls around ages 13–15 and in boys around ages 15–17.

What Is a Growth Plate Fracture?

A growth plate fracture is a break in the growth plate of a child or teen. They happen most often in the bones of the fingers, forearm, and lower leg.

How Do Growth Plate Fractures Happen?

Most growth plate fractures happen from falling or twisting. Contact sports (like football or basketball) or fast-moving activities (like skiing, skateboarding, sledding, or biking) are common causes. Growth plate fractures also can happen from repetitive activities, like training for gymnastics or pitching a baseball.

What Are the Signs & Symptoms of a Growth Plate Fracture?

A child with a growth plate fracture can have pain, swelling, and trouble moving and using the injured body part. Sometimes there is a deformity — this means that the body part looks crooked or different than it did before the injury.

How Are Growth Plate Fractures Diagnosed?

Health care providers will order X-rays if they think a bone is broken. Some mild growth plate fractures don’t show up on an X-ray, though.

What Are Growth Plate Fractures Treated?

Often, a growth plate fracture may be mild and need only rest and a cast or splint. 

But if bones are out of place (or displaced), they have to be put back into the right position with a procedure called a reduction. A reduction is also called “setting the bone.”

There are two types of reductions:

• A closed reduction is done in the emergency room or operating room, after the child has been given medicine to ease the pain. The surgeon gently moves the bones back into the right position. No incision (cut) is needed.
• An open reduction is a surgery done for a more complicated injury. It is done in the operating room under general anesthesia. The surgeon makes an incision and moves the bones into the right position. Surgical plates, screws, or wires often are used to keep the bones in place.

After an open or closed reduction, the child will usually wear a cast, splint, or brace to make sure the bones don’t move during healing.

Do Growth Plate Fractures Affect Bone Growth?

Most growth plate fractures heal and do not affect future bone growth.

However, sometimes changes in the growth plate from the fracture can cause problems later. For example, the bone could end up a little crooked or slightly longer or shorter than expected. If the bone does not grow normally, surgery or other treatments may be needed.

Looking Ahead

Most kids recover from growth plate fractures without any long-term problems. Help your child follow the health care provider’s directions. Go to all follow-up doctor visits to make sure the bones heal well and continue to grow normally.

Hand Fracture Symptoms, Treatment, & More

What is a Hand Fracture?

A hand fracture is a broken metacarpal bone of the palm of the hand or a broken phalangeal bone of the fingers of the hand. The metacarpal bones along with their corresponding fingers are described by roman numerals with the thumb being I, and the pinky finger being V. The phalangeal bones are further described by the segment of the finger. The finger bone closest to the palm is the proximal phalanx, the middle phalanx is of course, in the middle, and the distal phalanx forms the fingertip. In the thumb, or first finger, there is only a proximal and distal phalanx.

These bones are all small and delicate. Our hands and fingers are arguably the most used bones in our bodies. It should come as no surprise, then, that hand fractures are the most common type of fracture. Any of these bones can sustain an injury and fracture.

What causes a Hand Fracture?

Hand fractures are almost always traumatic injuries. Either the hand strikes an object, the hand sustains a direct blow, or something is dropped onto the hand resulting in a crush-type injury. A twisting injury can also occur. Occupations involving manual labor and contact sports are highly correlated with hand fractures. A fracture of the metacarpal head is known as a Boxer’s Fracture.

What are the symptoms of a Hand Fracture?

A hand fracture presents with pain and swelling around the location of the fracture. If the fracture is displaced, the hand may appear deformed or a finger may appear shortened. It may be impossible to bend a finger, or the position of the bent finger may be awry. In a Boxer’s fracture a knuckle may appear out of alignment. In an open fracture of the hand, the ends of the bone poke out through the skin.

How is a Hand Fracture Diagnosed?

A careful history and thorough physical exam documenting the nature of the injury and the circumstances under which it occurred is essential for the medical record. X rays will usually suffice for the diagnosis of the hand fracture although CT or MRI may be indicated for more severe fractures.

How is a Hand Fracture Treated?

Because of the importance of preservation of function of the hand, all finger fractures should be referred to a hand specialist for treatment.

Non-Surgical

In the emergency department, once a finger fracture is diagnosed it is usually splinted, pain medication is given, and a follow up appointment with a Hand Surgeon is given.

If the bones of the finger or hand are not displaced, the hand can be placed in a cast to immobilize it for 3-6 weeks while the bones heal. If minimal displacement is present, closed reduction can be attempted followed by placement of a cast. Hand therapy will usually follow to help the hand return to its full function.

Surgical

If the bones of the hand or finger are displaced, if tendons or blood vessels have been severed, or if an open fracture is present, surgery will be needed to repair the injury and give the best chance of a full recovery. Pins, plates, and screws can be used for internal fixation of the bones depending on the type of fracture sustained. Once the bones have healed Hand therapy will be prescribed to ensure proper return to health.

How can Dr. Knight help you with Hand Fractures?

Fractures to the hand can be traumatic and frightening injuries, which may have lasting effects to the mobility and function of the hand, so it important that you seek out the best care possible when having one treated. In his years of practice, Dr. Knight has trained extensively on the repair of fractures, and has treated an untold number of them, so that his experience lends him great skill and understanding of the problems that can arise as a result of fractures. If you want to be treated quickly, efficiently, and with skill, then Dr. Knight is the doctor for you.

See Dr. Knight, one of the best hand surgeons in Dallas and see if he can help you live a more pain free life. Come to our Southlake hand and wrist center or Dallas Fort-Worth friendly office location.

Testimonials

Dr. Knight saved my career! Thanks to Dr. Knight and his staff for the excellent treatment and care now I am able to lifeguard again with full motion of my right hand. Dr. Knight was able to see me the day I was told I needed to see a hand specialist and that I has broken my right hand. I was in surgery within three days and on my way to a quick and fast recovery. Now I am back to work and feeling amazing!!!

If I ever need treatment I will definitely be seeing Dr. Knight. Thank You!!!

Dylan Fait, Lifeguard

Hand Fractures Fact Sheet

Frequently Asked Questions:

How do I know if my hand is fractured?
As with all fractures, a fracture to the metacarpal bones of the hand will be accompanied by some form of trauma, and then quickly by pain, swelling, bruising, redness, and loss of function, depending on the severity of the break. If your hand is fractured in such a way that these apparent symptoms do not manifest, but you are still worried you may have suffered a break, you can undergo a physical examination to determine if you do, in deed, have a fracture, and an x-ray will show for certain if there is a break.

Do hand fractures require surgery?
Typically, a simple hand fracture does not require surgery, and can be rest manually by the doctor and splinted or cast, with pain and anti-inflammatory medication given to help with the swelling and pain. If the break is more severe or the bones are out of alignment, or if there are multiple pieces of bone that need to be put back into place, then surgery may be necessary, but it is generally a last resort.

Can a hand fracture heal on its own?
If the fracture in question is a hairline and the patient is able to adequately immobilize the hand for a period of time that will allow for healing, then it is possible, but generally people work and speak with their hands and so the level of immobility necessary to properly heal a fracture without some kind of intervention is impossible to reach. If you think you have a fracture, it is important to seek medical attention as soon as possible to avoid any complications that may arise from untreated symptoms of your injury.

How long does a hand fracture take to heal?
While the severity of the fracture and the general health of the patient can have some effect on the speed of healing, it usually takes somewhere from three to six weeks of immobilization for a fracture of the hand to heal completely.

Can a hand fracture heal without a cast?
Some fractures don’t require casting, and may only need a splint or wrapping, but in the case of the hand, it is best to immobilize the affected area in some way so that further injury is avoided.

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Disclaimer
HandAndWristInstitute.com does not offer medical advice. The information presented here is offered for informational purposes only. Read Disclaimer

Dr. John Knight

Dr. Knight is a renowned hand, wrist and upper extremity surgeon with over 25 years of experience. Dr. Knight is a Board Certified Orthopedic Surgeon and Fellowship trained. Dr Knight has appeared on CNN, The Doctors TV, Good Morning America, The Wall Street Journal, The Washington Post, Forbes, The Huffington Post, Entrepreneur, Oxygen network and more.

ABC of emergency radiology: Hand

BMJ. 2005 May 7; 330(7499): 1073–1075.

ABC of emergency radiology

Tudor Hughes, professor of radiology

University of California San Diego Medical Centre, San Diego, USA

The hand is exposed and at risk of injury. It is therefore not surprising that hand injuries are the commonest skeletal injuries, and they account for 10-20% of attendances at accident and emergency departments. Fractures of the phalanges are more common than fractures of the metacarpals. Fractures of the distal phalanx account for half of all phalangeal fractures. Metacarpal injuries occur most commonly in the thumb and little finger.

Dorsal (left) and lateral (right) view of left index finger

Most injuries of the hands are easy to detect and correlate well with clinical findings. Identification of injuries is essential because early detection and appropriate management usually leads to recovery of normal function. Conversely, delay in diagnosis of what seems to be a minor abnormality can lead to a severe disability. Surgery is rarely necessary and only indicated for specific injuries. Clinical examination determines which radiographic views should be obtained.

Anteroposterior (left) and lateral (middle left) view of thumb. Anteroposterior (middle right) and lateral (right) view of finger

Anatomy

Each finger consists of one metacarpal and three phalanges, and the thumb consists of one metacarpal and two phalanges. Each bone has a head, a shaft, and a base. Strong ulnar and radial collateral ligaments prevent sideways movement of the joints. The joint capsule of the interphalangeal and metacarpophalangeal joints is thickened on the palmar (volar) aspect and forms a dense fibrous structure (volar plate). This attaches to the base of the phalanx. Each finger has two flexor tendons and one extensor tendon. Sesamoid bones may be found on the palmar aspect of the hand, most commonly in the flexor tendons of the thumb at the level of the metacarpophalangeal joint.

Anteroposterior (left) and oblique (right) view of the hand

ABCs systematic approach

Assessment of radiographs should follow the ABCs system:

Anteroposterior (left) view of index finger showing soft tissue swelling over the proximal interpharangeal joint. The lateral view (right) confirms a dislocation

• Adequacy

• Alignment

• Bone

• Cartilage and joints

• Soft tissues

Adequacy

Anteroposterior and lateral views should be obtained for finger injuries, and anteroposterior and oblique views are needed for hand injuries. Special views may be necessary for specific injuries, such as thumb injuries.

Table 1

Alignment

Check the alignment of each finger and thumb on two views.

Bone

Exclude a fracture by carefully following the bony contour of each digit on two views. Then check the bone density and trabecular pattern. Occasionally, a vascular groove can be confused with a fracture.

Cartilage and joints

The joint space should be uniform in width. Overlap of bone margins may indicate a dislocation, and a second view should confirm this.

Soft tissues

Always use a bright light to look for soft tissue swelling. This may be the only sign of an injury. When radiographs are taken to detect foreign bodies a metallic marker should always be placed at the site of the injury, tangential to the site of entry. Foreign bodies may be visible on one view only.

Anteroposterior view of index finger showing crush fracture (left) and volar plate avulsion (right)

Injuries

Distal phalanges

Crush fracture

This is an extremely common injury in which the tuft is squashed and sustains a marginal chip or a comminuted fracture. Generally, a nail bed or pulp soft tissue injury is associated with a crush fracture.

Mallet finger without (left) and with (right) fracture

Mallet finger (baseball finger)

Often caused by a direct blow to the extended digit—there is an avulsion of the extensor tendon at its insertion to the base of the distal phalanx. A less common injury is an avulsion of a small fragment of bone from the dorsal aspect of the base of the distal phalanx. The diagnosis is clinical and obvious—a flexion deformity of the distal interphalangeal joint.

Radiography is done to assess the size of the bony fragment. Most of these injuries heal with simple splinting of the joint (with a mallet splint), but complete tears of the tendon may need surgery.

Middle phalanges

Boutonnière deformity

This is a deformity of the digit with extension of the distal interphalangeal joint, flexion of the proximal interphalangeal joint, and no associated bony abnormality on the radiograph. The extensor mechanism attachment is torn, and splinting in hyperextension of the proximal interphalangeal joint is indicated to prevent a long term fixed flexion deformity.

Volar plate avulsion

This fracture is quite common. It is secondary to a hyperextension injury and sometimes associated with a dislocation of the proximal interphalangeal joint. The avulsed fragment of bone is often very small and difficult to identify. The fragment is sometimes seen only on an oblique view as a tiny flake of bone, and the clue to its presence is soft tissue swelling.

Proximal phalanges

Spiral or transverse fracture

In this fracture the digit is often shortened and rotated; the injury is usually caused by of a direct blow. The deformity is generally more obvious when patients flex their fingers. Angulation is best evaluated with a true lateral view or oblique view. The anteroposterior view usually underestimates the degree of angulation and shortening.

Punch fractures of fifth metacarpal—head (left) neck (middle), and base (right)

Metacarpal bones

Punch fracture (boxer’s fracture)

This is the direct result of a punch. The neck of the metacarpal is fractured, and there is volar displacement of the head. Usually the fifth metacarpal is damaged, but injury can also occur at the head of the fourth or other metacarpals. The history and clinical findings are characteristic (although patients often deny they have been in a fight) with flattening of the knuckle. A degree of angulation is accepted as this causes negligible functional disability. The original description of a boxer’s fracture was a fracture of the base of the fifth metacarpal.

Other metacarpal injuries

Oblique or even transverse fractures of the shaft or base of the metacarpals can occur in one or more metacarpals. Sometimes the fracture occurs at the base and the carpometacarpal joint, and there is the possibility of an associated dislocation or subluxation of the joint. These fractures are sometimes best treated with pin fixation.

Anteroposterior view of the ring finger seems almost normal (left), but the oblique view shows an oblique fracture of base of fourth and fifth metacarpals (arrow)

Thumb injuries

Bennett’s fracture and dislocation

This is an oblique fracture of the base of the first metacarpal and dorsal dislocation or subluxation of the first metacarpal. The fracture extends to the carpometacarpal joint and the displacement is made worse and more unstable by the abductor muscles of the first metacarpal. The management of this injury is controversial. It can be treated by closed reduction with splinting, closed and percutaneous pin fixation, or open reduction and pinning. Referral to a specialist orthopaedic surgeon is mandatory.

Bennett’s fracture and dislocation

Gamekeeper’s thumb (skier’s thumb)

An abduction injury of the thumb occurs when there is outward distraction of the thumb and an avulsion of the attachment of the ulnar collateral ligament (which can be associated with a bony avulsion fracture). Stress films may show further widening of the joint space on the ulnar aspect, but these films are not recommended as they can aggravate the injury. Ultrasonography should confirm the diagnosis. These injuries may be treated conservatively, but complete tears of the ulnar collateral ligament may require surgery.

Gamekeeper’s thumb (skier’s thumb). Arrow shows fracture attached to ulnar collateral ligament (note the sesamoid)

Key points

• History is important because the mechanism of injury often provides a clue to diagnosis

• Clinical examination will give a strong clue to the diagnosis

• Early diagnosis and appropriate management is essential for full recovery

• ABCs systematic approach should be used to review radiographs

Notes

This article is adapted from the 2nd edition of the ABC of Emergency Radiology, which will be published in the autumn

The ABC of Emergency Radiology is edited by Otto Chan, consultant radiologist, Royal London Hospital, London (ku.oc.rednoyeulb@ottoediaz)

90,000 Damage to growth zones – treatment, symptoms, causes, diagnosis

The growth zone, also called the epiphyseal plate or physis, is a patch of growing tissue at the end of the long bones in children and adolescents. Each long bone has at least two growth plates, one at each end. The growth of the plate determines the future length and shape of the mature bone tissue. After the completion of growth at the end of puberty, the growth of the plates is completed and this zone is replaced by hard bone tissue.

Damage to the plates occurs in children and adolescents. The plates are the weakest area of ​​the growing skeleton, even weaker than the adjacent ligaments and tendons that connect bones to other bones and muscles. A child growing up with severe joint injuries is more likely to damage the growth plates than the ligaments responsible for joint stability. Injuries that can cause sprains in adults can damage the growth plates in children.

Damage to growth plates occurs in fractures.They account for 15 percent of all childhood fractures. They are twice as common in boys as in girls, and are most common in 14-16 year old boys and 11-13 year old girls. In girls in the older age group, fractures are less common, as the musculoskeletal system in girls matures earlier than in boys. As a result, in girls, the formation of bone tissue is completed earlier and the growth plates are replaced by dense bone tissue. About half of all growth plate injuries occur in the lower forearm (radius) or elbow.These injuries are also common in the lower leg (lower leg and fibula). They can also occur in the upper leg (thigh) or in the ankle and foot.

Reasons

Although growth plate injuries are usually associated with acute trauma (falling or hitting a limb), damage can also be caused by chronic trauma resulting from excessive frequent stress. For example, such damage to the growth plates can occur in athletes: gymnasts, track and field athletes, baseball players.

Based on certain studies of injuries in children, data have been obtained that damage to growth plates occurs as a result of falls on the playground or from chairs. Sports such as football, athletics and gymnastics account for one third of all injuries. Other physical activities, such as cycling, sledding, skiing and skateboarding, account for one-fifth of all growth plate fractures. Injuries from driving a car, motorcycle, and related traffic accidents account for only a small percentage of growth plate fractures.

If a child has pain after an acute injury or excessive stress that does not disappear or changes in physical activity or there is local soreness, then a doctor’s consultation is imperative. A child, in no case, should move through pain. Children who play sports often experience some discomfort as they have to perform new movements. In some cases, the appearance of certain unpleasant sensations is quite predictable, but, nevertheless, any complaint of the child deserves attention as some injuries, in the absence of adequate treatment, can lead to irreversible changes and disrupt the proper growth of the bones of the injured limb.

Although most growth plate injuries are associated with injuries during play or sports, there are other causes of damage to growth zones (eg, bone infection) that can alter normal bone growth and development.

Other possible causes of injury to growth plates

Child abuse can cause bone injury, especially in young children who are just beginning to grow bone.

Exposure to cold (eg, frostbite) can also damage growth plates in children and can result in short fingers in older age or early development of degenerative arthritis.

Radiation radiation, which is used to treat certain types of cancer in children, can damage the growth of the plate. What’s more, recent studies have shown that chemotherapy used to treat cancer in children can negatively affect bone growth. Long-term use of steroids for the treatment of rheumatoid arthritis has a similar effect.

The presence of certain neurological disorders in children that lead to sensory deficits or muscle imbalances increases the risk of growth plate fractures, especially in the ankle and knee areas.

These types of injuries are often seen in children who are born insensitive to pain.

The area of ​​growth zones is the site of application of many hereditary diseases that affect the musculoskeletal system. Science is gradually studying genes and gene mutations involved in the formation of the skeleton, the growth and development of bone tissue. Over time, these studies will help treat various abnormalities in the normal functioning of the growth plates.

Symptoms

• Inability to continue playing due to pain after an acute injury.
• Decreased ability to play for a long time due to persistent pain following an injury.
• Visually noticeable deformity of the child’s arm or leg.
• Severe pain and inability to move after injury.

Diagnostics

After clarifying the circumstances of the injury, the doctor will order an X-ray to determine the type of fracture and develop a treatment plan. Since the growth zones do not have the same density as the bones, X-ray does not visualize them and they are defined as gaps (gaps) between the metaphysis and the pineal gland of the long tubular bone.Due to poor visualization of growth zones on radiography, it is recommended to perform radiography of the paired limb for image comparison.

MRI (magnetic resonance imaging) allows you to clearly visualize changes in tissues and, therefore, can be prescribed to diagnose damage to growth plates. In some cases, it is possible to use other diagnostic methods, such as computed tomography (CT) or ultrasound examination.

Classification of growth plate fractures (Salter and Harris)

Fractures of growth plates are divided into 5 types:

• Type I
  The epiphysis is completely separated from the end of the bone or metaphysis, through the deep layer of the growth plate.The growth plate remains attached to the pineal gland. The doctor needs to perform a reposition if there is a displacement. With this type of fracture, immobilization with plaster of paris is required for full consolidation. As a rule, the likelihood of full restoration of the bone with this type of fracture is very high.
• Type II
  This is the most common type of growth plate fracture. The pineal gland, together with the growth plate, is separated from the metaphysis. As with type I fractures, type II fractures usually require reduction and rigid fixation with a plaster cast.
• Type III
  This type of fracture occurs in rare cases, usually in the lower leg, in the tibia. This occurs when the fracture passes completely through the pineal gland and separates part of the pineal gland and the growth plate from the metaphysis. Such fractures often require surgical restoration of the articular surface. The prognosis for such fractures is good if there is no violation of the blood supply to the separated part of the pineal gland and there are no pronounced displacements of the fragments.
• Type IV
  This fracture runs through the pineal gland, through the entire growth plate and into the metaphysis.This type of fracture requires surgical reconstruction of the bone geometry and alignment of the growth plate. If the reconstruction is not carried out efficiently, then the prognosis for this type of fracture may not be very good. This injury occurs most often at the end of the humerus next to the elbow.
• Type V
  This is a rare type of injury where the end of the bone is crushed and the growth plate is compressed. Most often, this type of fracture occurs in the knee or ankle. The prognosis is poor, since premature ossification of the growth zone is almost inevitable.
  A new classification, called the Peterson classification, also distinguishes between a type VI fracture, in which part of the pineal gland, the growth plate, and the metaphysis are missing. This usually occurs with open wounds or fractures (injuries from agricultural machinery, snowmobiles, lawn mowers, or gunshot wounds). With type VI fracture, surgical intervention is required, and in most cases, late reconstructive or corrective operations are necessary. Bone growth is almost always impaired.

Treatment

As a rule, a trauma doctor deals with the treatment of injuries (with the exception of minor ones). In some cases, a pediatric orthopedic traumatologist is required, since traumas in children often have their own characteristics.

Treatment for fractures depends on the type of fracture. Treatment, which should be started as early as possible after injury, is usually as follows:

• Immobilization. A plaster cast or splint is applied to the injured limb and restricts any activity of the child that may put pressure on the injured area.
• Reposition. In the presence of displacement of fragments, manual reduction or often surgical reduction with fixation of fragments is necessary. Fixation is necessary for normal consolidation of bone tissue. After reduction, a plaster cast is applied with the capture of the growth zone and the joint. Immobilization in a cast is necessary for several weeks to several months until normal consolidation of bone tissue occurs. The need for operative restoration of the integrity of bone structures is determined by the size of the displacement, the presence of a risk of damage to nearby vessels and nerves, and the age of the child.
• Exercise therapy is prescribed only after the completion of bone tissue regeneration. Long-term follow-up by a physician is necessary to assess adequate bone growth as the growth zones are injured. Therefore, it is recommended to carry out radiography of the extremities at intervals of 3-6 months, within 2 years after the fracture of the growth zones. Some fractures require follow-up until the child’s growth is complete.

Forecast

In almost 85 percent of growth plate fractures, complete healing occurs without any consequences.
Disorders of bone tissue formation during growth plate injury occur in the following cases:

• Severity of injury. If the injury causes impaired blood flow to the pineal gland, then the growth of bone tissue is impaired. Also, when the growth plate is displaced, destroyed or compressed, the growth of bone tissue may slow down. The presence of an open injury can entail the risk of infection and infection can destroy the growth plate.
• Child’s age. At a young age, damage to the growth plates can lead to more serious disruptions in the development of bone tissue, as a large increase in bone growth is required.And therefore, in case of fractures in early childhood, long-term medical supervision is required. At the same time, the younger bone tissue has a greater regenerative capacity.
• Localization of growth zones fractures. For example, growth zones in the knee are more responsible for extensive bone growth than others.
• Type of growth plate fracture – Type IV and V are the most severe.

Treatment depends on the above factors and is also based on prognosis.

The most common complication of growth plate fractures is premature arrest of bone growth. The affected bone grows more slowly than it would without injury, and as a result, the limb may be shorter than the intact limb. If only part of the growth plate is damaged, bone growth can be in one direction and limb curvature occurs. Growth injuries in the knee are at greatest risk of complications. Since trauma to the growth zone in the knee is often accompanied by damage to the nerves and blood vessels, therefore, injuries to the growth zones in the knee are often accompanied by impaired bone growth and curvature of the limb.

Currently, leading research clinics are conducting studies exploring the possibilities of stimulating tissue regeneration using the results of genetic engineering, which will allow in the future to avoid stunted growth and deformity of limbs after injuries of growth zones.

90,000 first aid, treatment, rehabilitation terms

Author Yulia Vladimirovna Dmitruk Read 10 min Viewed 1.8k. Published by 04.09.2018
Updated 11/04/2018

Isolated fracture of the finger on the dominant hand is common. Despite the seeming lightness of the injury, a person who has broken a phalanx loses his ability to work, while the harm to health is small, although complex injuries lead to disability. So, comminuted fractures can lead to dysfunction of the entire hand. If this is the leading hand, then the standard of living decreases, there are restrictions in everyday life, and professional activity suffers.

Classification

Typology of upper limb injuries implies the division of injuries by the nature of the fracture:

• longitudinal – the fault line is parallel to the injured structures;
• transverse – in everyday life they are also called perpendicular, since they intersect the axis of the bone tissue;
• screw-shaped – bone fragments are displaced in a spiral and turned over in the projection, which complicates the reposition;
• oblique – fall at an acute angle relative to the position of the injured bone.

If the joints are involved in the destructive process, they speak of fracture dislocation. Intra-articular injuries are dangerous and require monitoring at all stages of treatment. The presence of a wound makes it possible to differentiate an open fracture of the finger. If the tip is injured, the nail collapses. Such injuries are considered the most painful.

The localization of the injury in relation to the phalanges is important. So, there are trauma to the base, damage to the middle phalanx, fracture of the nail phalanx. In the latter case, they separately speak of a fracture of the nail tuberosity.This is an extra-articular injury, which is more often the result of compression.

It is difficult to say offhand what degree of damage occurs after a blow: it can be a simple bruise or a more dangerous injury. In the event of a fracture of the distal (nail) phalanx, the health consequences are minimal. If there is a fracture of the middle or proximal phalanx, there is a high probability of loss of sensitivity of the injured area. Thus, a fracture of the index finger reduces the function of the limb.A fracture of the middle finger negatively affects motility, but a closed fracture of the little finger, in which the first phalanx is injured, is easily transferred and quickly recovers.

By the nature of the destruction of bone structures, there are:

• Break – Minor damage that usually occurs during compression. Most often, such a fracture affects the 5th and ring fingers on the hand;
• fracture – more serious damage, implying destruction of more than half the diameter of the bone;
• Cracking – Typical for a direct hit during a fight or sparring.Fractures of the thumb, implying cracking, are rare, but other proximal phalanges can be affected, with a fracture of the little finger on the hand with an oblique or side impact is more common.

ICD trauma code 10

Injuries at the level of the wrist are coded according to ICD 10 code S62. An isolated fracture of a finger gets the code S62.6. If several fragments of the hand are damaged, assign the code S62.7.

Reasons

Fractures of the fingers are usually caused by direct impact or squeezing.Boxers and hand-to-hand combatants face similar violations even when wearing protective gear.

In children, a fracture of the little finger on the hand can occur due to the fact that the baby unsuccessfully fell on the hand or pinched the phalanx. When it hits the doorway, the tip is injured. It is not always possible to diagnose a crack in time. Exceptionally soft tissue appears to have been affected, but X-rays reveal bone fragments that do not heal properly if not treated properly.

Among pathological injuries, injuries caused by diseases of the musculoskeletal system are distinguished. So, the fragility of bones increases with osteoporosis and osteomyelitis. In the case of oncological diseases, the risk of trauma to bone structures also increases, due to which the functions of the limb are impaired.

Symptoms

It seems that such injuries should be tolerated more easily than other injuries of the musculoskeletal system, but the symptoms of a finger fracture are more pronounced.The painful sensations are extremely strong, sometimes acute pains cause traumatic shock.

If the fracture is accompanied by dislocation or rupture of the ligaments of the fingers, the phalanx goes sideways, the finger swells and turns blue, there is pain. Could there be a temperature with a broken phalanx ? In the case of an open wound and an inflammatory process, an increase in body temperature and the development of complications are possible.

Major signs of a toe fracture include:

• hematomas, hemorrhages, cyanosis;
• atypical mobility or limited movement;
• crepitus on palpation or flexion;
• Swelling and edema, injured phalanges appear unnaturally thick.

Symptoms of a thumb fracture can be confused with an injury to the hand. How to understand which bones are broken in this case ? A characteristic sign of a broken finger on the hand is the shortening of the phalanx. It is almost impossible to move the fingers, the damaged phalanx becomes thick. If you recognize the first signs in time, you can accurately understand the location of the damage. In the future, the symptoms of a finger fracture itself are difficult to recognize – swelling, pain and stiffness extend to the entire hand.

Side impact usually affects the little finger and ring finger. However, bone fracture does not always occur. Symptoms of a fractured little finger include deformity, misalignment. Otherwise, the symptoms of a fracture of any fingers on the hand are the same.

What to do in case of a broken finger

Adequate medical care for a finger fracture, which is first provided on the spot, will allow to avoid negative consequences. In case of skin damage, the wound is washed and disinfected.The impact on the nail phalanges is painful and difficult for the victim, therefore, as part of the first aid, the site of injury must be anesthetized. For this, cold or topical preparations with lidocaine are used. Effective pain remedies are non-narcotic analgesics: Ketorol, Ketanov, Nurofen, Analgin.

It is possible to stop heavy bleeding by means of bandaging. Immobilization plays an important role in finger fractures. It is necessary to fix the bone structures in order to prevent their displacement.For this purpose, tires made from scrap materials are used: a pencil or ballpoint pen, a tree branch, a stick from ice cream or lollipops, etc.

The injured limb is not overtightened. It is important to maintain immobility, but not to allow the hand to turn blue. It is better to keep the injured arm in a bent position, which will reduce the chances of re-bleeding. Immediately after the fracture of a finger and the provision of first aid, the victim is sent to the emergency room.

How to identify a broken finger

Identification of a fracture of one of the phalanges of the hand from other injuries of the musculoskeletal system allows instrumental diagnostics.It is possible to distinguish a crack or complete fracture of the bones from a dislocated finger during X-ray. It is not always possible to recognize the nature of the injury based solely on the symptoms, therefore, radiation diagnostics is mandatory.

How to tell if a finger is broken if there is no doctor nearby ? Deformations of bone structures and fragments visible in an open wound are obvious signs. However, this does not exclude the presence of simultaneous dislocation and rupture of soft tissues. Certain diagnostic methods allow the traumatologist to find out if there are any accompanying disorders, but be prepared to experience a stream of pain on palpation.

Treatment

Conservative therapy offers the treatment of a finger fracture using the closed reduction method. This method is suitable for uncomplicated injuries. Analgesics are given immediately after reduction. Medicinal electrophoresis is used for the same purpose. In case of acute pain, novocaine blockade is performed from the side of the lesion.

How to treat an injured organ in a specific case, the traumatologist decides. Therapies vary, but a plaster cast is more common. How much plaster to wear depends on the severity of the damage.Usually, when one phalanx is injured, it takes 3-4 weeks. A finger retainer is not worn for a long time after an injury to the distal phalanx of the finger. If you can quickly recover, then the bandage is canceled and therapeutic exercises are started. For some time after the fracture, edema persists – the tumor remains with severe damage to soft tissues. Salt baths and decongestant ointments help to remove it.

If the main signs of an uncomplicated finger fracture have disappeared, we can talk about recovery. Sometimes skin peels off after an injury – why does this happen ? This is due to the wearing of plaster and the lack of proper hygiene during the immobilization period. With proper care, peeling disappears.

Surgical treatment

The operation is required in difficult cases when the reduction of bone fragments by a closed route is impossible. It is impossible to cure a fracture of the main phalanx with crushing of the bone structure into fragments without serious medical intervention. In order to fix the fragments, osteosynthesis is performed.For this, a spoke is temporarily inserted. If the fusion process proceeds without complications, it is removed after 3 weeks.

A displaced thumb fracture often requires surgical correction. Sometimes a knitting needle remains in a finger for life. The installation of such structures is required in case of a complicated fracture with displacement or in the case of a previously incorrectly fused fracture that caused irreversible changes. After the bones are straightened, the tendons and muscles are sutured.

How to treat a broken finger at home

Fractures of the fingers cannot be called a minor injury.It is not possible to heal the damage at home without medical assistance. After the main therapy, the patient is advised to eat calcium-fortified foods and not disturb the injured limb.

How long does a finger fracture heal

If the injury is not complicated, the bones grow together within 4-6 weeks. Healing takes a long time when the ligaments and tendons are damaged. How long does a fracture of the little finger heal, not aggravated by concomitant disorders ? Under favorable conditions, 3 weeks are enough, sometimes the plaster cast is kept for 5 weeks.Only a doctor can answer the question of how long the fracture heals, since much is determined by the patient’s age, the complexity of the injury and the state of the musculoskeletal system.

Rehabilitation

Medicinal electrophoresis is recommended to improve recovery. During the same period, the diet is changed. Products containing magnesium, zinc and manganese help restore bone structures. They promote the absorption of calcium and promote fusion.

The doctor will explain how and when to develop a finger after a fracture.There is no need to overload the limb and force events, this can lead to chronic injury. Often, with a fracture, a plaster cast is worn, and therefore active actions for the period of mobilization are excluded. In the future, rehabilitation of a fracture of a finger after removing the plaster consists in performing gymnastics at home. The patient is encouraged to develop fingers after fracture with tennis balls and rubber rings.

For the period of rehabilitation, the doctor may advise performing monotonous work with phalanges: playing keyboards, knitting, etc.Modeling from plasticine, salt dough, working with sand, rubber balls and other methods aimed at developing fine motor skills are recommended.

Physiotherapy

Physiotherapist or rehabilitation therapist will tell you how to properly develop a finger after a fracture. Special exercises and remedial gymnastics for the fingers are recommended. Sorting rice or buckwheat will bring benefits. To develop individual phalanges of the finger after a fracture, splints are used that limit mobility.

After any fracture, hardware physiotherapy is performed. UHF, magnetotherapy, ozokerite applications for up to 10 procedures will help out. The development of fingers at home after a fracture begins even before the removal of the cast. A light hand massage will be beneficial, which will improve blood flow and regeneration. How to develop the fingers after removing the dressing, the doctor will tell you. At the initial stage, the most acceptable passive method: exposure to dry heat, self-massage. In the future, fingers should be developed actively – with the help of gymnastics, performing household functions.

Complications and consequences

In case of a finger fracture, negative consequences are possible. The hand can lose function, sometimes the injured finger does not bend or is deformed. Such complications arise as a result of self-treatment and refusal of medical care. Among other consequences of trauma:

• Osteomyelitis – develops as a result of tissue infection in case of injury. The course is difficult, often recurs. Surgical treatment;
• ankylosis – appears in case of damage to the articular surfaces.Leads to a complete restriction of movement, which is especially noticeable in everyday life. The damaged finger loses function, which can lead to disability;
• pseudoarthrosis – accompanied by the formation of a false joint, due to which the limb is unbend in the place that under normal conditions remains motionless. Treatment is performed surgically;
• pathological callus – if the fragments are not correctly aligned, the fracture is often complicated by limited movement due to excessively large callus;
• Contractures are one of the typical complications of trauma.Fracture of the phalanx of the toe leads to shortening of the tendons, which are responsible for the functionality of the limb. Sometimes the finger does not unbend and partially or completely loses its mobility.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you survived a similar trauma and successfully coped with the consequences! Your life experience may be useful to other readers.

90,000 Child’s finger fracture – causes, symptoms, diagnosis and treatment

Fracture of a finger in a child is a violation of the integrity of the main, middle or nail phalanx of a finger or toe. It manifests itself as pain, cyanosis, edema, hemorrhages, dysfunction, and sometimes external deformation. In case of damage to the nail phalanx, subungual hematomas are often formed. The diagnosis is inserted taking into account the circumstances of the injury, complaints, physical examination data, and radiographic findings.According to the indications, CT or MRI is prescribed. Treatment – reduction, immobilization with a plaster cast or dynamic splinting. Sometimes pin fixation is required. In the presence of wounds, surgery is indicated.

General information

Fracture of a finger in a child is a fairly common injury. The share of injuries to the fingers accounts for about 2% of the total number of skeletal injuries, the share of fractures of the toes is less than 1%. Most often, the nail phalanges suffer, a little less often – medium, even less often – the main ones.Severe injuries are rare. The importance of early adequate treatment of upper limb injuries is due to the need to preserve hand function.

Fracture of a finger in a child

Causes

Fractures of fingers in children occur as a result of household, street and sports injuries. Injuries to fingers can be caused by being hit by a heavy object, such as a hammer, pinched on a door, fighting, or unsuccessfully falling. Damage to the toes is often the result of hitting a hard object, for example, on a jamb at home or on the goal post while playing football.

Pathogenesis

Fracture of the phalanx of the finger occurs as a result of traumatic impact, the strength of which exceeds the strength characteristics of the bone. There may be a violation of the integrity of the middle part or epiphyses of the phalanx. As a rule, the fracture is single, linear and not accompanied by significant displacement.

Multiple finger injuries and comminuted injuries with gross displacement are rare and require special attention due to possible negative consequences.Most of the fractures are closed. Tearing off a part of the fingertip and the formation of a soft tissue defect in fractures of the terminal phalanx occurs mainly in preschool children.

Symptoms

A child with a broken finger complains of sharp pain in the damaged area. On examination, the finger is swollen, cyanotic. The injured phalanx is painful on palpation, axial load. In the presence of significant displacement, shortening and deformation are detected. Fractures of the nail phalanges are often accompanied by the formation of extensive subungual hematomas.The function of the brush is reduced.

Signs of a toe fracture in children are rapidly growing swelling, cyanosis, bruising, subungual hematomas, painful palpation and pressure along the axis. Support on the leg is preserved, while standing and walking, the child spares the forefoot, rests on the ground mainly with the heel.

Open fractures are characterized by irregular wounds, often with crushed and crushed edges. In the wound, the fat cells of the soft tissues of the phalanges are visible, sometimes bone fragments are visible.When a defect forms, a part of the skin and underlying soft tissues breaks off or hangs on a thin skin flap that does not have feeding vessels.

Complications

With a pronounced displacement and the absence of reduction in the long-term period, deformities of the fingers are formed. Non-repositioned intra-articular displaced fractures are fraught with limitation of joint mobility. In adulthood, children who have had finger injuries can develop post-traumatic arthrosis.

Diagnostics

Pediatric traumatologists are engaged in clarifying the nature of the injury.Fracture recognition is usually straightforward due to the rather vivid clinical picture. Due to the impossibility of productive contact and ambiguous X-ray data, some difficulties may arise in the diagnosis of injuries in young children, especially in the case of apical fractures of the nail phalanges and lesions of the growth zone. The following methods are used to confirm the diagnosis:

• X-ray of the finger. Basic technique for identifying most fractures.Pictures are taken in two projections. On radiographs, the fracture line, the number and direction of displacement of the fragments are visible.
• CT of the finger. Appointed in case of insufficient information content of the baseline study. Allows you to get a volumetric image of the damaged phalanx, confirm the presence and clarify the location of the fracture.
• MRI finger. Required in case of doubt in children of the younger age group and with suspicion of injury to the growth zone.It visualizes well cartilaginous tissue, which is practically invisible on conventional radiographs.

Fractures of fingers in children are differentiated from bruises. In favor of the bruise, there is a mild edema, the absence of deformity and pain with pressure along the axis.

Treatment of a child’s finger fracture

Conservative therapy

Treatment is more often conservative. For injuries without displacement, the fingers of the hand are fixed with a plaster cast for a period of 7-10 days.For patients with lesions of the index, middle and ring fingers, a plaster cast is applied on the palmar surface, the little fingers are immobilized with a splint on the lateral surface, the thumb is put in a cast separately from the rest.

In case of toe injuries, dynamic splinting is performed, bandaging the affected toe to the adjacent healthy one. For children with a fracture of the big toe, it is recommended to apply a plaster cast even if there is no displacement. In the event of displacement, the reduction is preliminarily performed, the hand or foot is fixed with a plaster cast.

Fragment matching can be difficult due to the small size of children’s phalanges. In difficult cases, percutaneous fixation is performed with a needle; in young children, an injection needle is used. The child is sent for a control X-ray; if the results are satisfactory, the immobilization is continued for 2 weeks. Then physiotherapy exercises are prescribed.

Surgical treatment

Surgical interventions are indicated for open lesions with soft tissue defect.Various options for skin grafting are used. Small wounds are closed with a local skin graft. To eliminate the defect in the flap cutting area, a skin graft taken from the inner side of the forearm is used. The flaps are pressed down with a gauze ball to improve contact with the underlying tissues and increase the likelihood of engraftment.

Large wounds are closed with a pedicle flap with a base in the area of ​​the palmar surface of the hand. The leg is cut off 3 weeks after the operation.The duration of immobilization after interventions to replace a soft tissue defect in open fractures ranges from 2 to 3 weeks or more, depending on the chosen technique, the severity of the injury, and the success of the flap engraftment. In the recovery period, physiotherapeutic procedures are carried out, exercise therapy is prescribed.

Prognosis

The prognosis for most children is favorable. Fractures of fingers and toes heal well, movements are preserved in full, residual deformities are absent.An unfavorable outcome is possible in the presence of displacement or open damage and late seeking medical help – in such cases, difficulties arise during reduction, early plastic surgery becomes impossible due to wound infection.

Prevention

Prevention of finger fractures in young children involves constant monitoring of parents, providing a safe space within the apartment, careful selection of conditions for walking and outdoor games.Middle-aged and older children should be taught the basics of safe behavior at home and outdoors. Instrument handling should be performed under parental supervision and after appropriate training. Classes in sports sections should be carried out under the guidance of a coach and using special equipment.

I ask for advice! Fracture of the main phalanx of the little finger on the leg with an offset

Girls, help me with advice … my head is already spinning ((

August 22, she hit the little toe of her left foot, the pain did not subside during the night + bruise

Let’s go to the traumatologist on VHI.They made an X-ray – a fracture of the main phalanx of the finger (little finger) with a displacement. Ledocaine was injected, the finger was set, a splint was applied to the middle of the calf and sent home to walk with a plaster cast for 4-6 weeks

Once a week I went to the doctor to check in; on the 3rd week, a control X-ray was taken. Heals slowly, so walk with a cast for 6 weeks.

I ask: how will the rehabilitation process proceed? how many days of sick leave will be given after removing the plaster to disperse (my husband had a similar fracture, but without displacement – he was given a week to more or less accustom his leg to stress).The doctor replied that he would give 3-4 days. This was the 4th week.

Also, the doctor advised to buy a semi-rigid orthosis, but after removing the plaster. must be selected individually. You need to wear an orthosis for a month, like rehabilitation. I ask: what does it look like, except for the little finger, should it cover, on the entire foot or on the front section? To which he replies: come to the orthopedic salon, they will pick everything up for you. I can’t tell you anything else.

On the 5th week (this Sunday), he tells me that he will remove the plaster on October 5 (and he works on this day from 16.00) and on October 6 in the morning he invites me to go to work. Because by the standards of the 5th, there will be just the exact number of sick days by the standards, but I can disperse at work too.

This is in view of the fact that the leg was motionless for 6 weeks! During the evening, you still need to buy an orthosis, footwear, in which it will be convenient to go to work with an orthosis (because you can only wear soft sports shoes, and I only have running shoes … you can’t walk in them for a long time).

And I have to go to work for 2 hours in public transport, which the doctor knows very well.

I.e. roughly speaking, I have a night to start walking at least a little bit and be able to get to work.

I decided to buy a brace in advance so as not to waste time on the evening of October 5th. I searched the Internet, toured a bunch of orthopedic salons (thanks to my husband) and found out: there are no orthoses for the little toe or the forefoot !!! There are no such people in nature !!! If I want, then of course I can be offered to assemble the orthosis for the little toe and the forefoot from the orthosis for the ankle, a special orthopedic insole and wrap the foot with the insole with kinesio tape… Moreover, they can offer an insole and ankle orthosis only of a certain company, of course not cheap. Total approx. 10,000 !!! for the little finger orthosis. And in other orthopedic salons they could not offer anything at all.

So how? The doctor insists on buying something that doesn’t exist at all. Sent to work in less than 24 hours after removing the cast.