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Broken finger?

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Friday, March 18th I fell while walking up some steps. When I attempted to catch myself, I bent my pinky finger wrong in my right hand. I havent seen a Dr for the injury because I dont have insurance.
The pain is in the last joint of my pinky finger (DIP) up to the nail.
I am able to bend it but with pain. I cant straighten it out all the way.
The tip of my finger seems to point off to the left slightly and lays against my ring finger when making a fist.
There is a large, red bump on the top that turns white across the center when bending my finger.
Its difficult to hold anything that has any resistance.
It has been over 2 weeks since the incident. The pain and redness has not subsided.
Ive noticed the skin beginning to peel across the injured joint though there were no skin abrasions associated with the injury.

Could I have broken or fractured my finger?

What measures should I take to stabilize this type of injury?

Is it too late to fix it since its been over 2 weeks?

And should I be concerned of the peeling skin?
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replied April 5th, 2011
Especially eHealthy

Without examining the finger and getting x-rays the following is just general information based on what you have written. That said...

The last joint is called the distal interphalangeal joint (DIPJ). It is commonly injured in a "jamming" type of accident. The distal phalanx in flexed quickly, before the tendon can adjust, causing either the tendon to stretch/rupture or for it to pull off a piece of bone. This is called a mallet finger (also referred to as a baseball finger). Since the extensor mechanism is disrupted, active extension (straightening) of the DIPJ is not possible. There is tenderness, swelling, discoloration (sometimes even under the nail), over the DIPJ.

Treatment of a mallet finger is to keep the DIPJ straight for six weeks, while allowing the next knuckle, the proximal interphalangeal joint (PIPJ), to bend. There is a special splint made just for this injury, called a Stax splint. You are getting to the limit of time for a non-operative treatment to work. The books say to give splinting a try, even as much as 4 weeks out from injury.

What if you don't treat a mallet finger? Most of the time, there will be a droop of the distal phalanx (the last part of the finger) and possibly a bump on the top of the knuckle. The discomfort usually resovles after about 8 to 12 weeks. Most people have no problems with the droop or bump, other than the cosmetic part. (I actually had a bony mallet finger of my right ring finger while in college. I didn't have insurance, so it wasn't treated. It took a couple of months before I could throw a ball without discomfort and I have a droop and bump. But, I have no other problems.)

There are some surgical procedures for specific types mallet fingers - ones that have a large chunk of bone pulled off and ones that involve part of the joint surface. However, they are far from perfect and the results are sometimes worse that what would have been obtained from conservative treatment.

It is not uncommon for the skin to peel, after there has been swelling. This is especially true around the base of the nail. On very rare cases, a mallet finger can even damage the germinal matrix of the nail, causing the nail to be deformed. But, again, this is rare.

Of course, without x-rays, there are other disorders that this could be. You say the small fingers turns toward the ring finger a little, which, actually it should. (If you gently let the fingers of your good hand close, the tips of the fingers should, in general, point toward the palmar base of the thumb. Often with swelling, the turning in of the small finger is more noticable.) However, you could have fractured off a condyle (the bases of the phalanx bone), longitudinally, causing the bone to shift. Or you could have ruptured one of the collateral ligaments. These are so uncommon, compared to how often mallet fingers occur.

Even with a thorough exam, some nondisplaced fractures can be missed. So, the only way to be sure, is to have an x-ray of the finger taken. Hope you are doing better soon. Good luck.
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replied April 5th, 2011

Your reply was 100% correct!! I decided to have my finger x-rayed today and found out I have a small hair line fracture in my DIPJ joint along with Mallet Finger. I was given a temporary splint and was referred to an Orthopedic Surgeon whom I have to call in the morning.

Thank you so much for the information!! You really helped out a lot!!
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