Symptoms
The main symptom of a broken finger is the onset of pain immediately after the injuring event. In some cases, the fracture can be detected directly from the outside if the finger is deformed. Depending on the fracture, the affected person may still be able to move the finger, albeit in severe pain.
Depending on the location and type of the fracture and the associated stability, some fractures are described as more painful than others. After some time, usually within 10 minutes, swelling appears on the affected finger and the mobility of the finger decreases. Swelling can also affect surrounding fingers, depending on its extent.
Dizziness of the finger also occurs in most cases, which can be explained by the compression of the surrounding nerves due to the swelling. Depending on the bone involved, if the distal phalanx, i.e. the bone under the fingernail, is affected, a red undercut fingernail may also occur, as bleeding (hematoma) may form there. In very extreme cases, it is also possible that the bone penetrates the structures to the outside and is now visible from the outside.
Fractures are generally painful, and so are finger fractures. A particular painful stimulus is given when the periosteum, the periosteum, tears. Bleeding occurs at the corresponding site and inflammation mediators are released.
These are certain messenger substances that are responsible for the typical characteristics of an inflammation. These include increased sensitivity to pressure and temperature, pain and swelling.This is due to the fact that the vessels at the injured site become permeable and water can leak into the surrounding tissue. At the end of the finger there is a fibrous structure that connects bone and skin and forms a network of very small compartments (subdivisions).
In these compartments, blood and fluid can collect in the distal phalanx of the fingers in the event of a fracture, which can lead to further swelling and severe pain. Since the nail bed is close to the bone, injuries can occur there as well, such as nail breakage or painful bruising (hematomas) (see: Bruising under the nail). In order to prevent swelling or to initially reduce it, all fractures should first be cooled with ice and stored high up so that less blood or fluid escapes (store against gravity)The goal of all therapy after a finger fracture is to correct the condition before the fracture as anatomically exact as possible and to ensure the mobility of the finger, i.e. to restore the function of the finger.
This can be achieved with a variety of different therapies, each of which is individually adapted to the injury. In any case, it is important to treat a finger fracture, as otherwise functional disorders of the hand can develop in the long term. For this reason, it is recommended that medical treatment be initiated as soon as possible after a fracture of the phalanx.
In most cases, surgical therapy is recommended in which a surgeon reconnects the bone ends with screws or a wire. Care must be taken to ensure that the soft structures surrounding the bone are protected as much as possible during the operation. In most cases, sufficient stability can be guaranteed after only 3 to 4 weeks.
In the case of fractures of the distal phalanx, a splint that immobilizes the finger is sufficient in most cases and usually allows healing after a few weeks. Bleeding, which often occurs with this type of finger fracture, should be removed to relieve the fingernail. In some cases, however, surgery may be necessary to fix free bone fragments in this type of fracture.
After the surgical therapy, exercises should be started as soon as possible to ensure the absolute functionality of the finger. The individual timing for the start of physiotherapy therapy is decided by the treating physician after an assessment of the finger after the operation. Non-displaced (displaced) fractures are immobilized with a splint for at least three to four weeks.
In the case of fractures of the end phalanx, the splint should extend beyond the fingertip to protect the finger from further injury. There are splints for this purpose that isolate the distal interphalangeal joint (the finger joint closest to the nail) so that the other joints remain mobile. This prevents stiffening of the other finger joints.
Most fractures heal well with conservative therapy after usually three to four weeks. More complicated shaft fractures often require longer immobilization. Even after splint/plaster therapy, the injured finger should be fixed to the adjacent finger with tape or similar for three to four weeks to stabilize it.
Under certain circumstances, however, surgery is recommended instead of splint therapy. This is the case when tendons, nerves or vessels are damaged, the joint is directly affected or there are serious nail/bed injuries. A hand surgeon should also be consulted if the finger fractures are twisted, significantly angled, shortened or otherwise deformed.
Tapering of a finger fracture is only considered as a primary measure immediately after the injury in extremely rare cases (especially in the case of an uncomplicated fracture of the little finger). This is because the stability provided by taping is simply too low to make a fresh finger fracture seem adequate. For this reason, a splint or plaster cast is used first (or after a possibly necessary operation).
Only when these have allowed an optimal healing process of the finger fracture over 3-4 weeks, the tape can replace them. For this purpose, the affected finger is attached to an adjacent finger using special medical tape.It is essential that the patient has the correct technique explained and demonstrated by a specialist, such as a physiotherapist. Otherwise, improper taping may force the finger into a wrong position, or the tape may not provide sufficient stability, thus jeopardizing the long-term maintenance of the previously achieved treatment success.
The decision to surgically treat a finger fracture is made taking into account various factors. First and foremost, the question of whether the finger fracture is a simple or a complicated fracture with several fragments. In the latter case, the decision to undergo surgery is made much more frequently.
Another important consideration is whether the individual pieces of bone on either side of the fracture line are displaced from each other or are still in their anatomically correct position. A displaced fracture should always be treated by surgery unless the displacement can be corrected by reduction maneuvers. This is followed by a similar therapy in the form of immobilization as for an undisplaced finger fracture.
A special case with regard to the treatment of a finger fracture is the open finger fracture. By definition, an open finger fracture is when the skin at the site of the fracture is no longer intact and the bone is therefore more or less exposed. Since an open fracture can serve as a possible entry point for pathogens, it should be surgically treated immediately.
First the fracture is treated and then the adjacent soft tissue is reconstructed as far as possible. Finally, the skin defect is closed to prevent infection. The surgical treatment of a finger fracture is a comparatively simple procedure.
The surgeon connects the two bone parts with a screw or wire. At the same time, possible concomitant injuries, such as tears in the finger tendons or bleeding under the fingernail, can be corrected. These are often the decisive aspect for performing an operation in the first place, since they rarely heal on their own without complications than the finger fracture itself.
