Fracture, Fingers and Thumb

© Reed Group

Risk: The risk of finger and thumb fractures increases with participating in contact sports (e.g., hockey, football), or skiing, particularly in children and adolescents. Bone or joint disease (e.g., osteoporosis), and poor nutrition (e.g., calcium deficiency) are also risk factors. Postmenopausal women and both men and women of advancing age are at increased risk of finger and thumb fractures as a result of accidental falls.

Incidence and Prevalence: Phalangeal fracture incidence is often difficult to determine because of under-reporting, but these fractures are estimated to comprise approximately 10% of all fractures (Divelbiss). A Canadian study of hand fractures found that phalangeal fractures comprised half of the 72,000 hand fractures studied. Annual incidence for hand fracture was estimated to range from 29 per 10,000 for individuals aged 20 or older to 61 per 10,000 for individuals younger than 20 years (Feehan, 2006). Fractures of the distal phalanx are the most common fractures of the hand and frequently result from industrial accidents (Lyn).

History: Presentation will vary depending on how the mechanism of injury. Individuals may report trauma to the area that could have seemed insignificant at the time. They may complain of pain, swelling (edema), sensations of numbness or coldness, and decreased range of motion in the affected digit.

Physical exam: Bruising (ecchymosis) and edema may be evident in the area of injury. Pressure applied to the finger elicits pain. Range of motion (ROM) evaluation may suggest loss of tendon function or bone instability. Strength testing of each digit and joint establishes tendon and ligament integrity. Sensory testing may be done to evaluate nerve damage. The injured hand is compared closely with the uninjured (contralateral) one. There may be observable deformity, but the cause may be tendon damage or joint dislocation without fracture.

Examination of the skin and nail bed for bloody effusion or open wounds is done to evaluate the need for antibiotics. It is important to distinguish between new and old injuries during the examination. Previous tendon and bone injuries may otherwise complicate the findings.

Tests: Plain X-rays with anteroposterior (AP), lateral, and oblique views will reveal the fracture location.

Individuals who sustain fractures of the fingers or thumb may require outpatient therapy. In such cases, rehabilitation can be administered by a physical therapist, occupational therapist or hand therapist. The duration of treatment is related to the location, type of fracture and length of immobilization. Protocols for rehabilitation must be based upon stability of the fracture and fracture management (operative, nonoperative). Hand dominance and the involved extremity will greatly influence the patient's degree of disability. The main focus of rehabilitation should emphasize restoring full range of motion and strength while maintaining independence in as many activities of daily living as possible. Resumption of pre-injury status is the goal with consideration of any residual deficit (Hritcko; Krop).

The goal of rehabilitation is to decrease pain and restore function. Modalities such as cold packs may be beneficial for controlling pain. Special attention should be paid to preserve full function of the uninvolved fingers, especially if the dominant hand is involved, provided this is not contraindicated by fracture stability. When indicated, the therapist will initiate range of motion and strengthening exercises of the involved digits, paying special attention to both the intrinsic and extrinsic hand muscles (Feehan, 2004). Emphasis must be placed on regaining full range of motion at each joint. Exercise intensity and difficulty should be progressed until full function is achieved (Hritcko; Krop).

Occupational therapy may be indicated to assist with activities of daily living.

If a finger or thumb fracture is operatively managed, the protocol of rehabilitation will be guided by the treating physician.