Non-operative treatment of common finger injuries

Abstract

Finger fractures are common injuries with a wide spectrum of presentation. Although a vast majority of these injuries may be treated non-operatively with gentle reduction, appropriate splinting, and careful follow-up, health care providers must recognize injury patterns that require more specialized care. Injuries involving unstable fracture patterns, intra-articular extension, or tendon function tend to have suboptimal outcomes with non-operative treatment. Other injuries including terminal extensor tendon injuries (mallet finger), stable non-articular fractures, and distal phalanx tuft fractures are readily treated by conservative means, and in general do quite well. Appropriate understanding of finger fracture patterns, treatment modalities, and injuries requiring referral is critical for optimal patient outcomes.

Fig. 1

(a) This image shows a rotational malalignment of the ring finger (crossing over the small finger) from a fracture at the base of the proximal phalanx of the ring finger. Due to a fairly normal looking appearance of the hand with the fingers extended the injury was initially treated non-operatively. Notice the gap between the middle and ring fingers, and the deviation of the ring finger from the normal cascade. The patient was treated with an operative reduction and percutaneous pinning. (b) A normal finger cascade with all fingers pointing toward the thenar eminence is seen in the same patient 4 weeks after surgery. Passive finger flexion is demonstrated using the tenodesis effect that occurs with passive wrist extension

Fig. 2

(a) AP radiograph showing a distal tuft fracture (arrow) (b) Typical clamshell splint used to protect a tuft fracture

Fig. 3

(a) Lateral radiograph of a mallet fracture (b) Dorsal splint used for mallet finger (soft tissue or bony mallet). Notice slight extension pre-bent into splint to assist in reduction of the avulsed fracture fragment seen in Fig. 3a. Patients treated with dorsal splints should be examined frequently for dorsal skin breakdown under the splint

Fig. 4

AP radiograph of a long oblique fracture of the proximal phalanx. The inherent instability of the fracture pattern will lead to suboptimal finger function if treated non-operatively

Fig. 5

Lateral radiograph of a boxer’s fracture (arrow)