A broken finger, medically known as a phalangeal fracture, is a common injury that immediately impacts the function of the hand. The hand is an intricate tool, composed of 27 bones and numerous joints, allowing for delicate manipulation and strong gripping. A fracture in any of the bones can severely disrupt this complex system, leading to limited dexterity and grip strength. The timeline for seeking treatment is extremely important because successful recovery depends heavily on aligning the bone fragments before the body begins its natural healing process.
The Critical Window for Acute Treatment
The most effective period for treating a broken finger is immediately following the injury, generally within the first one to three weeks. During this initial, or acute, phase, the primary goal is anatomical reduction, meaning the broken bone pieces must be correctly realigned. If the fracture is displaced, a procedure called closed reduction is performed, where the doctor manipulates the fragments externally.
Once aligned, the finger is stabilized using a splint, cast, or buddy taping to an adjacent finger, allowing the bone to heal in the correct position. If the bones are severely displaced, unstable, or involve the joint surface, surgical fixation with pins, screws, or plates may be necessary. Follow-up X-rays are often taken about a week after the injury to confirm the alignment has been maintained, as fragments can sometimes shift. This initial window is important because the bone is still mobile, and non-surgical methods have the highest chance of restoring the finger’s original structure and function.
Understanding Malunion and Nonunion
Missing the acute treatment period increases the risk of the fracture healing incorrectly, leading to long-term complications. The two main consequences of delayed treatment are malunion and nonunion.
Malunion occurs when the bone heals in an incorrect anatomical position, such as with excessive angulation or rotation. This typically becomes established after three to four weeks when the bone callus begins to harden. A rotational malunion, even a subtle one, is particularly problematic, causing the affected finger to overlap an adjacent finger when making a fist. Angulation and shortening also lead to decreased range of motion, pain, and a loss of grip strength.
Nonunion is the failure of the bone fragments to heal entirely, leaving a persistent gap or an unstable fibrous connection. While less common, nonunion is often associated with more complex injuries, such as open fractures, bone loss, or infection. A diagnosis of nonunion is considered if the fracture shows no signs of healing after six months. Both malunion and nonunion compromise the structural integrity of the hand, leading to functional impairment and stiffness.
Corrective Options for Long-Term Injuries
Even after the initial window has closed and a malunion or nonunion has formed, treatment is still possible, though it becomes more invasive. Corrective surgery is required to address these long-term injuries and improve function.
Treating Malunion
For a malunion, the standard procedure is an osteotomy, where the surgeon re-cuts the bone at the site of the deformity. This intentional re-breaking allows for precise realignment, followed by internal fixation with small plates or screws to ensure stability during the second healing process.
Treating Nonunion and Stiffness
Nonunions usually require the removal of nonviable tissue from the fracture site and a bone graft to stimulate new bone growth. In cases of severe damage or chronic stiffness involving the joint surfaces, a salvage procedure such as joint fusion, known as arthrodesis, may be necessary to eliminate pain and stabilize the finger. While these delayed interventions can restore function, the outcome is often less ideal than if the fracture had been treated promptly in the acute phase.