I would like to present the journey of a 24-year old who I treated for a little finger fracture (broken little finger) referred to me, 6 weeks after her initial injury. Finger deformities are a common complication that can occur following fractures of the phalanx and metacarpals. These deformities can affect both the appearance and function of the hand, making it difficult to perform everyday tasks(figure 1a and 1b). X-rays can show very subtle findings, and to a non-specialist, can be deceiving(figure 2a & 2b) . Hence, a hand surgeon always correlates the X -ray findings with the clinical assessment of the hand. A good old adage hold so true, especially in Hand surgery: “Treat the patient, not the X-ray.” Fortunately, with proper management and treatment, many of these deformities can be corrected or minimized.
There are several different types of finger deformities that can occur following a phalanx or metacarpal fracture. These include angulation, rotation, shortening, and malrotation. Angulation occurs when the bone heals in a crooked position, while rotation occurs when the bone is twisted in the wrong direction. Shortening occurs when the bone heals shorter than it should be, while malrotation occurs when the finger is twisted in the wrong direction.
One of the most common treatments for finger deformities following a phalanx or metacarpal fracture is surgery. This may involve cutting and realigning the bone, or fusing it together with a metal plate(figure 3a & 3b). In some cases, the surgeon may also need to lengthen or shorten the joint to improve function.
Another important aspect of managing finger deformities is rehabilitation. This may involve exercises to strengthen the hand and fingers, or splinting to keep the hand in the correct position while it heals. Hand therapy may also be recommended to help the patient re-learn how to perform everyday tasks with their hand.
In addition to surgery and rehabilitation, there are several other steps that can be taken to manage finger deformities following a phalanx or metacarpal fracture. These include managing pain and swelling with ice and medication, avoiding using the affected hand for heavy lifting or gripping, and practicing good hand hygiene to avoid infection.
Overall, the management of finger deformities following a phalanx or metacarpal fracture requires close collaboration between the patient, their healthcare provider, and possibly a specialist in hand surgery and a hand therapist. With the right treatment plan and commitment to rehabilitation, it is possible to achieve optimal outcomes and regain function of the hand(figure 4).