Richard A. Bernstein, MD
Fractures can occur anywhere in the finger and usually respond well to splinting or casting. The important thing about fractures of the finger is how the injury can ultimately affect motion and strength. These injuries can oftentimes lead to stiffness and a permanent loss of motion if not addressed; even with the best of care, loss of motion is not uncommon.
A commonly asked question is the difference between a fracture, break, and crack of the bone. All terms are identical; though occasionally there is the misconception that a crack is simple. What you need to understand is the location and degree of stability of the injury, but for all three terms, the bone is broken and needs to be recognized.
The other two confusing terms are comminuted and compound. Comminuted refers to multiple fragments which are therefore inherently less stable. A compound fracture is also knows as an open fracture. This means that there is a cut overlying the break or the bone has punctured the skin. A compound fracture has a higher chance of infection.
It is important to differentiate fractures that go into the joint from those that do not. When a break goes into a joint, there is a higher chance of arthritis developing if the joint does not remain clean and smooth. Other breaks can sometimes occur in areas where the fracture will block motion and these also need to be addressed differently. Fractures that go into the joint have less tolerance for displacement and may need surgery.
For stable fractures, (the clarification of which you should ask in the office), casting or splinting is usually the method that we choose. The key is understanding the instructions about when you can start moving the fingers and hand and when you should stay still. I use the example of a seesaw between immobilization and motion. The longer we immobilize a break, the more stable it will be but also more stiff. On the other side of the seesaw is motion; the earlier we move it, the better the motion may be, but there may be greater difficulty with healing. Therefore, we need to balance the seesaw to gauge between motion and stability.
When fractures need to be fixed, there are different options of pins, screws, and plates. Not one method is applicable for all fractures. Based on their location, size, instability, there are different options available that you should discuss with me.
Copyright © 2010, TOG All rights reserved.
Revised 12/17/10, updated 1/28/2016