Phalangeal Fractures (Hand)

The phalanges in the hand are the bones of each finger, with the distal phalanges at the top, the intermediate phalanges below (except for on the thumb), and the proximal phalange attaching the fingers to the metacarpals in the hand. Fracturing a phalange is a common injury in sports activities and other traumatic incidents, often estimated as being the most common of all fractures, and the injury can compromise finger or hand movement. Without proper treatment this can result in ongoing problems.

Symptoms

The symptoms will vary depending on the specific injury and how it was caused. For instance, if the fingertip is struck or crushed then the tissue beneath the fingernail might be damaged along with the distal phalange, leading to discolouration. Intermediate phalanges regularly become inflamed and bruised when fractured, and such fractures can also result in reduced range of finger motion. Many phalangeal fractures can also lead to visible deformities, either at the location of the fracture or the end of the bone. Most of the subtler symptoms, such as rotational abnormalities, are best checked by a doctor.

Causes

Several mechanisms can provoke a phalangeal fracture, but younger athletes are particularly prone to fracture by sports injury. Any severe strike that hits or crushes into the finger can potentially cause a fracture, and this can occur during many high speed contact sports in which the frequency of collisions is high (e.g. rugby or hockey). A bad fall onto the fingers can also result in a fracture. Outside of sports, fractures are often caused through accidents involving machinery.

Medical Treatment

See a doctor quickly so that they can examine the injury and check for various deformities and symptoms. This is especially important in determining whether the fracture is stable or unstable, which can radically alter the course of the treatment. Surgery (e.g. pinning, or fitting plates or screws) may be required for a number of fractures and this will be assessed on a case by case basis. If the phalangeal fracture requires only conservative treatment then a period of immobilisation is usually commenced, during which it is important to rest and stay away from strenuous activities. This period should not exceed 3 weeks because that could lead to inflexibility in the fingers. Removable splints are often used after this point.

Complications

Complications affecting finger motion can arise depending on individual circumstances. The most widespread complication is mal-union of the fracture, meaning that the finger does not heal in its exact previous shape or alignment. This can affect your ability to perform intricate motions or grip with normal strength. Repeated fractures to the same finger increase the risk of ongoing poor movement. Non-union can occur in a fracture involving more severe bone or tissue damage, though this is rare.

Rehabilitation

Hand therapy is a key factor to successful recovery. A specialist in the field should be able to lead you through the initial stages of regaining successful motion in the affected fingers. Stiffness may have accumulated due to a period of immobilisation, so a gradual build up in flexibility will be needed.