FINGER FRACTURES
Trauma Conditions Fractures Finger Fractures
Thumb Fractures 
Finger Fractures Wrist Fractures Scaphoid Fractures
All four of our fingers have three bones (phalanges) and three joints. This differs from the thumb, which only has 2 phalanges. The digits are very strongly attached to the metacarpal bones at the knuckle joint (or the metacarpophalangeal joint) through strong collateral ligaments, giving it a very stable foundation. The finger is progressively more at risk of injury and instability as it goes towards the tip. The proximal interphalangeal joint is the most vulnerable, as it allows for more movement and is anatomically more vulnerable than the last joint of the finger (the distal interphalangeal joint). Therefore, we find most of the fractures are around the proximal interphalangeal joint. This may be a true fracture or an avulsion fracture, where the ligament or tendon pulls a piece of bone away from its bony attachment.
The proximal phalanx is commonly involved in rotational-type injuries causing long oblique fractures, usually due to a rotational, torsional force, e.g., when a dog leash is wraps around and twists the finger, causing a fracture.
The distal phalanx is most involved in direct, blunt crushing-type injuries, which can cause a fracture under the nail. Fractures under the nail are associated with nail bed injuries, both of which need to be repaired surgically, as these crush injuries are usually open fractures and need to be washed out to prevent the risk of infection.
Another variation of distal phalanx fractures is seen when the extensor tendon pulls off of a piece of bone in a mallet-type fracture. A mallet fracture is also seen in crush-type injuries, for example, when a cricket ball hits the tip of the finger. This impact causes a fracture that also involves a piece of cartilage inside the joint and requires surgical repair.
Treatment
The treatment of fractures is based on whether the fracture is displaced or if there is any angulation of the finger, i.e. if the finger is obviously skew and/or rotated. These fractures will need to be surgically treated. The principle for any treatment is aimed at obtaining a stable fixation, ensuring the fingers can move as quickly and early as possible. Painful swollen fingers following a fracture quickly become stiff. The stiffer the finger, the harder it is to rehabilitate and mobilise the finger/s back to the normal range of movement. Small avulsion fractures associated with proximal interphalangeal joint dislocations are treated conservatively with splinting and hand therapy.
Any rotational injuries of the proximal phalanx or middle phalanx are treated surgically, reducing it perfectly and fixating it with a plate. Distal injuries related to a crush injury are often open injuries and are treated on merit. A large fracture fragment seen in mallet injuries, where the extensor tendon is involved, is surgically repaired and immobilized with the K-wire across the distal interphalangeal joint.
Finger injuries in children
In children, finger fractures can go through the growth plate, the cartilage centre that drives the growth in bones. In children, the proximal phalanx is very commonly at risk, especially the little finger When the fracture goes through the growth plate, it creates a deformity and these fractures need to be corrected surgically, as a malunion, where the bone heals in a sub-optimal position, can occur.
FAQ
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Oblique proximal phalanx fracture
Dorsal fracture of distal phalanx
The anatomical structures of the finger
Open reduction and internal fixation of proximal phalanx fracture with lag screws