Hand & Finger Fractures
Broken bones in the fingers or the metacarpals - the long bones of the palm - which may be treated with or without surgery depending on position and stability.
The hand contains 27 bones, and their precise alignment matters more than in almost any other part of the body. A small amount of rotation in a finger bone that would be irrelevant elsewhere can cause fingers to cross over one another when you make a fist.
Not every broken bone in the hand needs an operation. Many heal well in a splint or cast. The decision rests on whether the bone is in an acceptable position, whether it will stay there while it heals, and what the hand needs to do afterwards.
Alongside the bone, the surrounding tendons, nerves, blood vessels and skin are assessed - an injury forceful enough to break a bone can involve more than bone.
Loading anatomy
Common symptoms
- Pain, swelling and bruising after an injury
- A visible bend, shortening or rotation of a finger
- Fingers that cross over each other when making a fist
- Difficulty or inability to move the finger
- Tenderness directly over the bone
- A wound over the fracture site, which changes the urgency considerably
Causes and contributing factors
- Direct blows and crush injuries
- Falls onto the hand
- Sports injuries, including a ball striking the fingertip
- Striking a hard object with a closed fist
- Machinery and workplace injuries
- Weakened bone, which can fracture with less force
How it is evaluated
Assessment covers the bone and everything around it. Rotation is checked with the fingers bent, because it can be invisible with the hand flat and obvious with the hand closed.
Any wound near a fracture is taken seriously - a break in the skin over a broken bone is treated as an open fracture until proven otherwise.
- Examination of alignment, rotation and stability
- Assessment of tendon function, sensation and circulation
- Careful inspection of any wound, including small puncture wounds
- X-rays in several views
- CT scanning in selected cases, particularly for fractures involving a joint surface
Clinical detail
Assessment addresses angulation, rotation, shortening, articular involvement and stability. Tolerance for deformity differs markedly by bone and by plane - considerable angulation may be acceptable in a small finger metacarpal neck fracture while minimal rotation is acceptable anywhere.
A wound over a metacarpophalangeal joint sustained striking another person is managed as a bite injury with a high index of suspicion for joint contamination.
Nonsurgical treatment
When a fracture is in an acceptable position and is stable, it can often be treated without surgery. The priority is to protect the healing bone while keeping as much of the hand moving as possible, because stiffness is a genuine risk in the hand.
- A splint or cast, often designed to protect the injured finger while leaving the others free
- Buddy taping to an adjacent finger in selected fractures
- Early, guided movement to limit stiffness
- Repeat X-rays to confirm the position is holding
- Hand therapy during and after healing
Surgical treatment
Surgery is considered when a fracture cannot be held in an acceptable position, when it involves a joint surface, when the bone is unstable, when several bones are broken, or when there is an open wound.
The aim is stable alignment that allows movement to begin, because a perfectly healed bone in a stiff hand is not a good outcome.
- Pins placed through the skin to hold the bone
- Plates and screws where more stable fixation is needed
- External fixation in selected complex or contaminated injuries
- Washing out and management of open fractures
Recovery
Bone in the hand typically unites over several weeks, but regaining movement usually takes longer than the bone takes to heal. Hand therapy is often central to recovery.
Some swelling and stiffness for months is common, and a permanent small loss of motion can follow more severe injuries.
- Structured hand therapy for motion, then strength
- Graduated return to work and sport, planned around the specific injury
- Hardware is generally left in place unless it causes a problem
When to seek urgent care
Seek immediate medical attention - an emergency department - if you experience:
- A wound over a broken bone, or bone visible in a wound
- A finger that is pale, blue, cold or numb
- Obvious deformity or a finger pointing in the wrong direction
- Any injury from a bite, including striking a tooth with a closed fist
- Severe uncontrolled pain or rapidly increasing swelling
This list is not exhaustive. If something about your hand worries you, have it looked at.
Frequently asked questions
Can I just tape it to the next finger?
Buddy taping is genuinely appropriate for some fractures and completely inadequate for others. The difficulty is that the two can look similar from the outside. A hand that has been injured hard enough to break a bone is worth having examined and X-rayed.
Why does rotation matter so much?
Because the fingers do not work in isolation. A few degrees of rotation in a finger bone can make that finger cross over its neighbour when you close your hand, which interferes with grip permanently. Rotation is one of the main reasons a fracture that looks minor on X-ray may still need correction.
How long until I can use my hand normally?
It depends on which bone, how it was broken and how it was treated. Bone healing is usually several weeks; full function often takes longer. Your surgeon can give a timeline specific to your injury.
Related conditions
Wrist Fractures
Breaks involving the end of the forearm bones or the small bones of the wrist, most often after a fall onto an outstretched hand.
Complex Hand Trauma
Severe injuries that damage more than one tissue system at once - bone, tendon, nerve, blood vessel and skin together.
Tendon Injuries
Cuts, ruptures or damage to the cords that connect muscle to bone and make the fingers and thumb move.
Discuss hand & finger fractures with Dr. Champagne
A consultation begins with understanding your symptoms, how they affect what you do, and what has already been tried.