Finger fractures and mallet finger

Finger fractures are breaks in the small bones of the fingers (phalanges) or in the long hand bones that connect to them (metacarpals). Mallet finger is a related injury in which the tendon that straightens the fingertip tears or pulls off a small piece of bone, so the tip of the finger droops and cannot straighten on its own. These injuries are common with sports, falls, and accidents at home or work.

A finger fracture may cause:

• Pain, swelling, and bruising
• Tenderness over the bone
• Difficulty bending or straightening the finger
• A finger that looks crooked, shortened, or out of line
• A finger that crosses over its neighbor when you make a fist
• A sunken knuckle after punching something hard (a boxer's fracture)

Mallet finger causes:

• A fingertip that droops at the last joint and cannot be straightened without help
• Pain, swelling, and bruising on the back of the fingertip, often after the tip was struck by a ball

Finger fractures result from falls, crush injuries such as a finger caught in a door, twisting injuries, striking something with a closed fist, car crashes, and contact sports. Bones weakened by osteoporosis break more easily.

Mallet finger usually happens when an object, often a ball, strikes the tip of a straightened finger and forces it to bend. Occasionally a minor bump is enough.

A clinician examines the finger for swelling, deformity, cuts, and joint stability, and checks that the tendons and nerves are working. Making a fist shows whether a finger is rotated out of line.

X-rays confirm a fracture and show its pattern. For mallet finger, they show whether a piece of bone was pulled off and whether the joint has shifted. Follow-up X-rays are often taken to make sure the bones stay in position while they heal.

Treatment depends on which bone is broken, whether the break is stable, whether it extends into a joint, and whether the skin is broken.

Non-surgical treatment of fractures: many finger fractures are treated with a splint, cast, or buddy taping to a neighboring finger. If a bone is out of place, it may first be moved back into position without an incision (a closed reduction). Protection usually lasts a few weeks, and motion is started as soon as it is safe, to limit stiffness.

Mallet finger is usually treated with a splint that holds the fingertip straight all the time, day and night, for several weeks, followed by a period of splinting at night. The fingertip must stay straight even while the splint is changed or the skin is cleaned; letting it bend can disrupt healing and lengthen treatment.

Surgery may be recommended for fractures that are badly displaced, rotated, or unstable; breaks that extend into a joint; open fractures in which bone has broken through the skin; and some mallet injuries with a large bone fragment or a joint that has slipped out of line. The bones may be held with pins, screws, or small plates.

Stiffness is a common problem after finger injuries, so moving the fingers as soon as your clinician says it is safe, and hand therapy when recommended, are important parts of recovery. Swelling can linger for weeks to months.

After mallet finger treatment, the fingertip may not straighten completely and a small bump may remain at the joint, even when the finger works well. Return to sports and heavy use depends on the injury and is guided by your clinician.

Wearing appropriate protective gear for sports, taking care around doors and machinery, and keeping bones strong may lower the risk of hand and finger injuries.