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Finger Fractures

By Danielle Campagne, MD, Assistant Clinical Professor, Department of Emergency Medicine, University of San Francisco - Fresno

Common finger fractures include avulsion fractures and crush fractures of the fingertips.

  • When a fingertip is crushed, it is tender and swollen, and the nail may be bluish black and raised up.

  • Sometimes the area becomes more sensitive and remains that way long after the fracture has healed.

  • Doctors take x-rays from several angles to diagnosis a fingertip fracture.

  • A fractured fingertip is treated with a protective covering or finger splint and, if needed, drainage of blood under the fingernail and surgery to realign the broken pieces of bone.

Avulsion fractures occur when a tendon or ligament pulls off a small piece of bone.

Fingertip fractures (also called tuft fractures) usually result from a crush injury, such as a hammer blow.

Avulsion Fracture of the Finger

In avulsion fractures, a tendon or ligament pulls off a small piece of bone.

Symptoms

A fractured fingertip is swollen and tender. Usually, blood accumulates under the nail (called a subungual hematoma). The nail looks bluish black and may be raised up. The nail bed, located under the nail, may be torn. This injury is very painful. If the nail is badly injured, it often remains misshapen.

After a severe finger fracture, sensitivity in the area sometimes increases (called hyperesthesia) and remains increased long after the fracture has healed. The area may remain very tender.

Diagnosis

  • X-rays

If people think they may have fractured a finger, they should see a doctor.

To diagnose finger fractures, doctors take x-rays from several different angles.

Treatment

  • A protective covering

  • For a large subungual hematoma, possibly drainage of the blood from underneath the nail

  • For severe fractures, surgery

For most fingertip fractures, doctors wrap the fingertip with a protective covering (such as an aluminum and foam splint). People wear this covering for about 2 weeks.

For large subungual hematomas, doctors may make a small hole in the fingernail with a needle or a hot wire (electrocautery device) and drain the blood out (called trephination). Usually, this procedure takes only a few seconds, and drugs to prevent pain are not needed.

For severe finger fractures, surgery is done to realign the many, separated pieces of broken bone.

If the nail is severely injured, the nail is usually removed. Then tears of the nail bed can be repaired. The finger is wrapped in a dressing to protect the nail bed. However, for most finger fractures, nail removal is not necessary.

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