Non-operative treatment of common finger injuries

Current Reviews in Musculoskeletal Medicine, Dec 2007

Finger fractures are common injuries with a wide spectrum of presentation. Although a vast majority of these injuries may be treated non-operatively with gentle reduction, appropriate splinting, and careful follow-up, health care providers must recognize injury patterns that require more specialized care. Injuries involving unstable fracture patterns, intra-articular extension, or tendon function tend to have suboptimal outcomes with non-operative treatment. Other injuries including terminal extensor tendon injuries (mallet finger), stable non-articular fractures, and distal phalanx tuft fractures are readily treated by conservative means, and in general do quite well. Appropriate understanding of finger fracture patterns, treatment modalities, and injuries requiring referral is critical for optimal patient outcomes.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs12178-007-9014-z.pdf

Non-operative treatment of common finger injuries

Matthew E. Oetgen Seth D. Dodds Finger fractures are common injuries with a wide spectrum of presentation. Although a vast majority of these injuries may be treated non-operatively with gentle reduction, appropriate splinting, and careful follow-up, health care providers must recognize injury patterns that require more specialized care. Injuries involving unstable fracture patterns, intra-articular extension, or tendon function tend to have suboptimal outcomes with non-operative treatment. Other injuries including terminal extensor tendon injuries (mallet finger), stable non-articular fractures, and distal phalanx tuft fractures are readily treated by conservative means, and in general do quite well. Appropriate understanding of finger fracture patterns, treatment modalities, and injuries requiring referral is critical for optimal patient outcomes. - Non-operative treatment Boxers fracture Bone and joint injuries of the hand are common. While often viewed as trivial injuries, a poorly treated finger fracture can have significant functional consequences. These injuries may result in chronic pain, stiffness, and deformity; preventing patients from participating in General principles of treatment The goal of treatment for any finger injury is to restore the normal function of the finger. Restoration of bony anatomy is the basis for returning normal function; however, an anatomic reduction is not always necessary to achieve this goal, especially if it comes at the cost of soft tissue scarring and loss of motion. To initiate early hand motion, fracture stability must be present either through the inherent stability of the fracture, splinting, or internal fixation. Early motion prevents adhesions of the gliding soft tissues of the extensor and flexor tendon systems and prevents contracture of the joint capsules. Immobilization of fingers much beyond 4 weeks will lead to long-term stiffness due to extensor tendon and joint capsular scarring. For example, non-articular phalangeal fractures treated with closed reduction and splinting are mobilized after 34 weeks, once the fractured phalanx is less tender. Even if splinting of one joint is needed, splints should be made small enough to allow early motion of uninjured joints. Closed non-displaced or minimally displaced fractures with acceptable alignment that are the result of a lowenergy trauma usually have sufficient supporting tissues remaining intact making them stable and amenable to treatment by protected mobilization, either with local splinting of the fracture or buddy taping to adjacent fingers. Fractures with rotational or angular malaligment may be amenable to closed reduction and splinting, but these fractures are at risk for incomplete reduction and recurrent deformity. These more unstable fractures require careful and frequent clinical and radiographic follow-up. Surgical treatment is indicated for any fractures of the articular surface, open fractures, fractures with significant shortening or malrotation, and fractures which fail closed reduction. Delayed treatment of these surgically indicated fractures is always more difficult, with worse functional outcomes due to stiffness, incomplete deformity correction, and post-traumatic arthritis. The signs of injury are usually obvious: pain, swelling, tenderness, ecchymosis, deformity, and/or skin abrasions. The differential diagnosis for finger injuries includes fracture, collateral ligament rupture, and tendon laceration or avulsion. A careful examination of the flexor tendons, extensor tendons, and neurovascular function must be documented. At a minimum, three x-ray views of the injured hand must be obtained with the imaging beam centered over the metacarpophalangeal (MCP) joint of the long finger. The posterioranterior (PA), lateral, and oblique views screen for trauma. PA and lateral views of the injured digit centered on the PIP joint should be obtained when a particular digit is of concern. Principles of closed treatment Closed reduction may be performed via axial traction followed by reversal of the deformity. For digital fractures, the intrinsic muscles can be relaxed by flexion of the MCP joints. Once the reduction is performed, the digit is examined to determine the stability of the reduction. Rotational alignment is checked by active finger flexion, observing the planes of the nail beds, and assessing for digital overlap. The fingers should all point toward the scaphoid tubercle (Fig. 1). If pain prevents active flexion, use of tenodesis with gentle wrist extension can result in digital flexion. A radial or ulnar gutter type splint with the MCP joints flexed as close to 90 as possible will hold the digits aligned while relaxing the intrinsics and preventing collateral ligament contracture. Although splinting at 90 of MCP flexion is preferable, as little as 60 of MCP flexion is likely adequate to place the collateral ligaments on maximal strain, and may be easier to achieve. In the case of (...truncated)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs12178-007-9014-z.pdf

Matthew E. Oetgen, Seth D. Dodds. Non-operative treatment of common finger injuries, Current Reviews in Musculoskeletal Medicine, 2007, pp. 97-102, Volume 1, Issue 2, DOI: 10.1007/s12178-007-9014-z