Trauma Conditions Fractures Finger 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.


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.


1Can a finger fracture heal without surgery?
Most broken fingers can heal without the need for surgery. However, treatment depends on the type of finger fracture and whether the fracture is displaced.
2How do you heal a fractured finger without surgery?
A finger cast or splint can be used to heal a broken finger.
3What happens when you do not treat a broken finger?
An untreated finger fracture can lead to a hand deformity and stiffness in the finger.

Please read the above text for more in-depth information to help answer these questions. It's important to consult with our qualified healthcare professionals to ensure the appropriate diagnosis and treatment plan for your specific situation.

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