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Question about Fractured finger tip left to heal

I fractured my fingertip about 5 or 6 years ago and was about 15 and stupid at the time, and I actually neglected medical care and let it heal crooked because I was scared of my parents finding out. I had an X-Ray done on it about a year ago and my doctor told me that it was a cosmetic thing and the joint isn't actually broken because it's fully healed.... It's truthfully about 80% strength and my wrist and hand is really weak when I grip things for too long and I have been thinking about getting it fixed for years...it's highly bothersome.

It's the joint on the tip of my right ring finger, I guess referred to as a Phalange if I'm not mistaken..it's bent to the left at about a 45 degree angle.. I have pictures but not sure how to upload them. Is it still possible to have this finger re-broken and healed straight somehow? I want to know if it's even possible to re-align the tip of my finger after all these years....and if I would even have sufficient strength after it healed. I'm fully committed to getting this done just want to know if it's still medically possible or if I'm going to have gimped grip strength for the rest of my life
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First Helper User Profile Gaelic
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replied July 10th, 2012
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Valygar,

You do not state which of the phalanges you broke. Was it the distal one, the middle, or the proximal? You do say that it was the fingertip, so I am assuming that you mean the distal phalanx.

You have noted that you do have decreased grip strength in that hand, but it may not be coming from a malunion of the distal phalanx. Yes, it is true that the small and ring fingers are the digits that are responsible for power grip, the tendons that attach to the distal phalanx attach at the base of the phalanx, right next to the joint.

Usually, malunions of the distal phalanx occur distal to the condyles (the flairs at the base that help make up the DIPJ - distal interphalangeal joint). The tendons and collateral ligaments attach to the condyles. So, the pull of the tendons is not actually affected. In fact, you can amputate through the distal phalanx and not affect grip strength at all, as long as you do not violate the tendon attachments.


So, as the physician advised you, this is mostly a cosmetic problem. And, it is difficult to find a hand surgeon that will do surgery for a cosmetic problem in the hand. The hand credo is - above all else, do no harm. Do not possibly cause problems with function, to make it look better.

The other problem, it is very technically difficult to do an osteotomy (cut the bone) in the distal phalanx, bone graft it, hold it with orthopedic fixation (pins usually), and then get the darn thing to unite again, without causing too much stiffness in the DIPJ. Also, doing surgery risks damage to the sensory nerves to the tip of the finger, which you also do not want to do.

As they say in American baseball, it would be a very long run for a very short slide.


But, you never know till you ask. You can see a hand surgeon (or a plastic surgeon who has training in hand surgery), to see if it is even feasible.

Good luck.


PS: if the fracture was in the middle or proximal phalanx, that is a different story. Fractures in those phalanges can cause problems with grip strength, because they can change the functional length of the tendons, affecting the pull of the tendons, and thus power. But, again, actually doing the surgery to correct a malunion is difficult, with many potential problems. You would have to weigh the risks against the benefits, very carefully.

Again, good luck.
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replied July 12th, 2012
Thanks for the reply I really appreciate it. I guess I'm probably stuck with this deformity for the rest of my life.. I think I will see my doctor one last time and see if there is anyway around the cosmetic aspect because it feels truly weakened and has ruined my passion for jiu jitsu which requires massive amounts of grabbing and pulling with the fingertips. Perhaps she can refer me to a hand surgeon for a better opinion. This is a really tough pill to swallow.. wish I could get it fixed without any worries Sad

I thank you again for your reply, it means more than you know
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replied July 12th, 2012
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Valygar,

You will definitely have to see a hand surgeon (or a plastic surgeon with hand training). No other surgeon will even try, and nonsurgeons do not even know the indications for the surgical procedure.

So, you may have to see your primary care physician to get a referral, but it is the hand surgeon that will make the ultimate decision.

Surgical procedures are also possible, on the drawing board. It is actually getting it to work in the real world.

The distal phalanx is just such a small bone to deal with, but it has been done. So, you might find a hand surgeon willing to take the chance.

You just have to be aware of the potential problems. And, be willing to accept the complications, if they do happen to occur. There's always a chance of ending up worse off than you were before. That is where the expertise of the surgeon comes in.

Each surgeon has to weigh everything, and then decide if the procedure has a good chance of succeeding, in their hands. Not all hand surgeons have the same experience and skill.

But, you never know till you ask.


Good luck.
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replied August 2nd, 2012
What are the exact problems/risks associated with surgery?
Gaelic...what exactly are all of the problems associated with getting surgery on the broken tip of your finger? I have broke the tip of my left pinky finger and all I keep hearing is I need surgery. It happened 6 weeks ago and it is swollen, but not much pain. I can still play hockey (goalie - which is how I hurt it) and do kickboxing. I have full range of motion. It doesn't even hurt when I squeeze it. The xray does show a break and also a small piece of bone "floating" to the side. I just want to avoid surgery at all costs if I can. Your information would be greaty appreciated.
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replied August 2nd, 2012
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hckychik,

It is hard to give you specific information, without actually examining the finger and seeing the x-rays.

However, there are several fracture patterns in the distal phalanx (the distal bone in the finger). Some can be left to heal on their own, while others should usually be fixed.


Crush injuries at the tip of the bone (like you get from smashing your finger in a door) are usually left to heal on their own. The only thing in them is to make sure that the nail bed (the area under the finger nail) is not disrupted. It is common, in this fracture pattern, for the patient to develop a significant subungual hematoma (blood under the fingernail). If the patient is having a lot of throbbing with the hematoma, holes are made in the nail plate to allow the blood to drain and relieve the pressure. But, the underlying little bone fragments are just left of consolidate on their own. The tip is protected with a splint, for the patient’s comfort.


If the distal phalanx is fractured within the body of the phalanx, and it is still well aligned, then these are just treated in a splint for 4-6 weeks and allowed to heal. If the phalanx is significantly angulated (bent) and unstable, then it is usually recommended that the fracture be reduced and pinned with a Kischner (K) wire. The wire is removed after about 6 weeks.


If the fracture involves the DIPJ (the distal interphalangeal joint - the last knuckle), and the fragments are displaced beyond certain limits, then surgery is usually recommended. However, there are some special intra-articular fracture patterns.

In a mallet finger (also called a baseball or knock-down finger), the extensor tendon has been pulled off the bone. These can usually be treated in a special splint called a Stax splint. The patient usually has a bump on the top of the knuckle, but function is fine. Some surgeons push to fix all of these, but usually they do not really need to be fixed.

In a rugger jersey injury, the flexor tendon is pulled off the bone. These almost always need to be surgically fixed.

Tiny avulsion fractures of the collateral ligaments off the base of the phalanx are treated like a Grade III sprain. These rarely need surgery as they will heal well with some immobilization and time.



You asked about the possible risks and complications of surgery on a finger. Well, this includes all of the usual risks associated with any surgical procedure (pain, bleeding, infection, failure of surgery to work, need for further surgery, reaction to medications, and death).

Specific risks to procedures on the finger include scarring, stiffness, loss of function, damage to anatomical structures in the surgical site (such as nerve, arteries, tendons, joint surface, etc), failure of orthopedic fixation devices, need for rehabilitation, and prolonged recovery.


Surgery on the finger is a delicate business and should not be entered into lightly. If it is needed to restore function, then, well, it is needed. But, again, without actually seeing what the injury is, it is not really possible to be more specific.


However, you state that it happened six weeks ago. In most cases, the bone is pretty well healed by that time (you usually like to do surgery within the first few days after the injury). You state that you have full range of motion and it doesn’t really hurt too much anymore. Sounds like it is pretty well healed. It is hard to make a patient who has full range of motion much better. That is pretty much a successful outcome.

Fingers will stay swollen for a long time after a significant injury. It is not uncommon for it to take several months for the swelling to go away, and in a small number of cases, the swelling (enlargement) of the finger can be permanent.

Of note, fracture lines will stay visible on finger x-rays for quite a while after the fracture is clinically healed. Which is why the decision of whether or not to continue immobilization is based on the patient’s clinical exam and symptoms, not totally on the x-ray.


But, again, if you have full range of motion and the fracture is not painful, you would be hard pressed to make the finger better with surgery.


Have fun playing hockey. Good luck.
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replied November 14th, 2012
Broken #3 Distal Phalanx
Gaelic,

Thank you for this informative chat thread. Three weeks ago tomorrow, I slammed my finger in my rear SUV hatch window. I broke my #3 distal phalanx on my left hand. I've been wearing a splint ever since. My doctor said to wear the splint for four weeks. The fingertip is still very tender, bruised and "tingly". I was wondering, how long does it take for the finger/bone to heal. When could I start using the finger without fear of damaging it again?
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replied November 14th, 2012
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rachelep,

Sorry about your accident.

In crush injuries to the finger tip, activity is usually allowed whenever the patient can tolerate it. For most patients with significantly crushed distal phalanges that takes about four weeks.

In most cases, if there is two (maybe three) big pieces, these will heal back together. If the tip has been crushed into several small pieces, then what usually happens is that the pieces sort of coalece together with a wad of collagen (scar, cartilage tissue). This is usually enough to support the nailbed and nail plate, and allow for attachment of the flexor/extensor tendons.

Some patient will develop nail plate deformities, if the germinal nail matrix is damaged. Some patient will develop of flail fingertip, where there is motion in the pad of the finger. This happens because the pieces of bone do not completely heal back together. In most people, this is not a big problem. Some people, such as mechanics or others who have to use their fingertips for manual labor do have problems. If the tip becomes flail, and it is problematic, the usual treatment is amputation through the flail part, but leaving the attachments of the tendons at the base of the distal phalanx. Surgery to try to get the bones to heal back together is fraught with problems and is very rarely successful. This is often tried, if the patient cannot come to terms with an amputation, just so that the patient can say everything was tried.

But, this rarely occurs. In the vast majority of cases, the patient's fingertip heals up just fine, it just takes some time.


The tingling is due to injury to the very tiny nerve endings in the finger tip. This will eventually heal, or new ones will grow in. Depending upon how badly they were injured, determines how long it will take for the tingling to go ways. That can range anywhere from a few days to a few months.


So, after about four weeks, you can start to try to do things with the finger, letting pain be your guide. If it still really hurts to do something, don't do that yet. You need to get the finger moving, if you have not already been doing that. If the DIPJ (the last knuckle joint) has been immobilized, it is going to be very stiff. It often helps to warm the finger/hand up with hot packs before doing range of motion exercises.

You will notice that impact activities (like typing) will probably hurt the worst. Pinning down and sliding objects along a surface (like sliding a coin off a table) might also hurt, as that activity puts a bending moment on the broken distal phalanx. But, you can start to try to do activities as much as you can, as tolerated. You will probably notice at first you just keep that finger out of the way ("sticks out like a sore thumb"), but as the discomfort subsides, you will use it more and more.


So, again, you can start using the finger at around the four weeks mark, just let pain be your guide.

Good luck.
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replied October 29th, 2014
fracture to pinky finger
Gaelic

I had a hairline fracture to my pinky finger at the center and inspite of doctors attention, I later came to know that I have a malunion to my pinky finger. The range of motion has been affected, but my functional day to day life is still not affected much. I do get conscious about the finger, and a mild pain comes, if it is hit somewhere. Now its been more 4 months after the accident.

Do you think I should do a surgery?. I am honestly confused whether to do it or not. As I am still able to go ahead with my day to day activities. My friend said, if I don't do anything, I might get arthritis there. From outside, it does look like a finger mildly swollen, and also you could make out the improper alignment of the bones at the middle.

Thanks
Sandeep
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