Fracture of the phalanx of the finger
Our fingers make very fine, coordinated movements and disruption of these movements can have a huge impact on daily and professional activities. To maintain full hand function, it is important that all finger fractures are evaluated by a physician to determine appropriate treatment. If you think that a broken finger is a minor injury, then you are seriously mistaken. Without proper treatment, a fracture of the finger can cause serious problems: limited flexion of the finger (contracture), pain with minor loads, decreased grip of the hand, whether it is a fracture of the nail or the main phalanx of the finger.
Anatomy of hand bones
The human hand is formed by 27 bones:
- 8 carpal bones;
- 5 metacarpal bones;
- The 14 bones that form the fingers are called phalanges. The first finger has only two phalanges: proximal and distal. Unlike the rest of the fingers, which consist of three phalanges: proximal, middle and distal.
Fractures of the metacarpal bones of the hand account for 30% of all hand fractures in adults.
Reasons for development
Exostoses of the fingers and toes may represent an osteochondroma, i.e., a benign tumor, or be a consequence of injury, chronic inflammation, or even prolonged wearing of tight shoes. The latter factors more often provoke the formation of exostoses in adults.
Osteochondromas are mainly typical for children and adolescents under 20 years of age. They can be single or solitary, as well as multiple. Solitary osteochondromas of the fingers and toes are a rare occurrence. More often, in the presence of exostoses with such localization, similar lesions of other skeletal bones are found, in particular the femur, tibia, humerus, spine, clavicle, etc.
The reasons for the formation of osteochondromas have not yet been fully established. It is believed that isolated neoplasms of this kind are a consequence of displacement of the epiphyseal plate. This may be due to disorders of embryonic development, radiation therapy at an early age, or exposure to other types of ionizing radiation. Epiphyseal plates are areas of bone growth that are made up of cartilage and are located directly under the “head” of the bone. Due to the fact that its cells are in the process of constant mitotic division, the child’s bones lengthen as they grow older. Subsequently, the cartilage cells located furthest from the epiphyseal plate ossify and form bone tissue.
If, due to the action of one factor or another, a fragment of the epiphyseal plate moves to the side, it continues to synthesize new cells, which also gradually ossify. This is how exostosis forms in children. Initially, it is represented only by cartilaginous tissue, but over the years it becomes dense and hard, but the cartilaginous cap remains. It usually grows in proportion to the rate of bone growth, and therefore is usually detected during puberty, when a sharp growth spurt occurs.
Multiple exostosis disease is considered to be a hereditary disease. Massive skeletal damage by exostoses is usually detected in early childhood and requires dynamic monitoring, since with it the likelihood of malignancy of neoplasms increases. Single exostoses become malignant in less than 1% of cases.
Types of finger fracture
Because of
- Traumatic fractures are damage to the finger bone due to trauma.
- Pathological fracture - a fracture of a finger in the area of pathological restructuring (affected by any disease - osteoporosis, tumor, osteomyelitis, etc.) Osteoporosis is the most common cause of a pathological fracture.
The nature
- Closed fractures (without breaking the skin)
— Incomplete
— Complete
- Open fractures (with skin damage)
— Primary open
— Secondary open
Based on the presence of offset:
- Fractures without displacement of fragments
- Displaced fractures.
Symptoms
In some cases, exostosis of the toe or hand is asymptomatic. If it forms on the side of the finger, it can cause manifestations of soft tissue hyperkeratosis. But since their volume is relatively small, a full-fledged callus is not formed. If you remove areas of thickened skin, the discomfort does not go away, and the tissues soon become keratinized again.
When exostosis reaches a large size, it injures soft tissues and provokes inflammatory processes in the joints. This leads to discomfort or even pain, especially when wearing tight shoes. It can also protrude beyond the physiological boundaries of the finger. When palpated, exostosis is a dense bony protrusion with a smooth or rough surface. This further aggravates the discomfort.
With active growth of the tumor, the phalanx may become deformed, as well as neighboring fingers. This already leads to the development of an aesthetic defect.
At a certain location, exostosis can compress the neurovascular bundle. The consequence of this is local swelling of the finger, a feeling of numbness or goosebumps.
The most common condition is exostosis of the big toe. This may be accompanied by valgus deformation of this finger, which is manifested by its deviation from the normal axis towards neighboring fingers. As a result, 2-3 toes may also become deformed, acquiring a hammer-like shape.
With subungual exostosis, there is a protrusion at the end of the phalanx of the finger, which looks like a thickened subungual ridge. In this case it is observed:
- pain when pressing on the nail, fingertip, or during physical activity;
- impaired nail growth, up to ingrowth or peeling;
- redness of soft tissues;
- callus formation.
Diagnosis and treatment of a fracture of the phalanx of the finger
If you have symptoms of a fractured phalanx, you should go to your local emergency room. Where, after examination, radiography will be performed in two projections of the damaged segment. The doctor must determine not only the location of the fracture, but also the type. The bone can be broken in several directions. A fracture of the phalanx can be transverse, in a spiral, into several fragments, or comminuted, i.e. collapse completely.
Treatment of finger fractures depends on three main factors:
- First, is the joint affected?
- Second, is the fracture “stable” or “unstable”?
- Third, is the finger deformed?
If the fracture involves a joint (intra-articular fracture), it is important to ensure that the articular surface is not destroyed and the fragments are not separated, i.e. no offset. In this case, you can do without surgery.
Second, it is important to define a “stable” or “unstable” fracture. The stability of the fracture can be determined by radiographs. A fracture is considered unstable if the fragments are displaced, or the nature of the fracture is such that even after proper reduction (elimination of displacement), the fragments can move over time and remain in a displaced position. The anatomy will naturally be disrupted, which may affect the function of the finger and hand.
The doctor must determine whether there is shortening of the segment or whether the distal fragment is rotated (rotated relative to its axis). The fingers on the injured hand should line up and look the same as on the healthy one.
If the articular surfaces are destroyed or the fragments are displaced, if the fracture is unstable, if there is a deformity that needs correction, then in this case surgery is necessary to restore the normal anatomy of the hand and preserve function after the healing of the finger fracture.
Conservative treatment
If a finger is fractured without displacement, the following assistance is provided: the damaged segment of the hand is fixed with a plaster splint or a polymer bandage, which is lighter and stronger than plaster.
Sometimes an adjacent finger is used as a splint, firmly fixing them together with a bandage. This makes it possible to work with a hand and bend your fingers without fear that bone fragments will move.
If after reposition the fragments have shifted, there is instability of the fracture, a comminuted fracture, or the deformity cannot technically be eliminated, then surgery is necessary. With the help of metal structures, fragments can be fixed in the correct position until the fracture heals completely. If the fracture is displaced, the doctor should try to correct the displacement of the fragments without surgery. This is performed under local or regional anesthesia. If the displacement is not eliminated, then there are indications for surgery. After the displacement is eliminated, the finger is fixed with a plaster splint or polymer bandage to prevent secondary displacement. Fractures of the phalanges heal in 3-4 weeks. During these three weeks, control (repeated) radiographs are taken at 10 and 21 days to ensure that there is no secondary displacement in the cast. After this, the plaster is removed and active development of the hand joints begins.
Surgery
Depending on the type and severity of the fracture of the phalanx of the finger, an operation may be required - osteosynthesis (osteo - bone, synthesis - create, restore), thanks to which anatomical restoration of the damaged structures is achieved.
During the operation, open reposition of the fragments (comparison of broken parts) and fixation with metal structures occurs. And for each fracture, an appropriate metal structure or a combination of them is selected:
- Plate
- Screws
- Spoke
If the patient categorically refuses surgery, then percutaneous insertion of millimeter titanium wires for fixation is possible.
The advantages of this method: simplicity and short manipulation time, absence of an incision and, as a consequence, a postoperative scar.
Disadvantages: one end of the wire remains above the skin so that the wire can be removed after the fracture has healed; the risk of wound infection and penetration of infection into the fracture area; long-term wearing of a plaster cast for 1 month; the impossibility of starting early development of the joints of the hand, resulting in the risk of irreversible contracture (lack of movement in the joint) of the injured finger.
Frequently asked questions about the disease
Which doctor should I see for arthritis of the fingers?
It is better to immediately see a rheumatologist; if necessary, he will refer you for consultation to another specialist.
Can folk remedies be used for treatment?
You can, but not on your own, but only as prescribed by a doctor.
Rheumatologists often prescribe hormonal drugs; are they harmful?
Hormones are prescribed in short courses to eliminate pain and swelling. Such treatment cannot harm.
Arthritis of the fingers often develops unnoticed. It is very important to pay attention to aching pain in your fingers in a timely manner and consult a doctor in a timely manner. But even if you have missed time and obvious signs of arthritis appear, do not despair: you can help at any stage. It is difficult to completely cure a chronic disease, but it is quite possible to stop its progression, relieve you of pain and improve your quality of life. Doctors at the Paramita clinic (Moscow) know how to do this.
Literature:
- Zabolotnykh, I.I. Diseases of the joints / I.I. Zabolotnykh. - M.: SpetsLit, 2009. - 256 p.
- Velyaminov, N.A. The doctrine of joint diseases from a clinical point of view / N.A. Velyaminov. - M.: State Publishing House, 2011. - 434 p.
- Shostak N. A. Psoriatic arthritis: new approaches to treatment // Clinician. 2008. No. 2. P. 41–45.
Themes
Arthritis, Joints, Pain, Treatment without surgery Date of publication: 11/13/2020 Date of update: 04/03/2021
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Rehabilitation
The duration and complexity of the recovery period are determined by the type of surgery performed. After marginal resection, discharge can be carried out on the day of surgery, but patients are advised to limit physical activity for 2 days. Drug therapy is also prescribed to reduce the risk of developing infectious complications and eliminate pain. After 2 days, a dressing is required, the stitches are removed after 7-10 days.
When performing a corrective osteotomy, recovery is more complex and lengthy. It involves immobilization of the operated finger, which is necessary for the healing of an artificial fracture.
Thus, exostoses of the fingers and toes are a rare phenomenon, but can significantly reduce the level of physical activity, cause cosmetic defects, pain, and generally worsen the quality of life. The solution to the problem is only possible through surgery. In this case, the operation is usually simple and does not require complex recovery. The main thing is to contact an orthopedic traumatologist as soon as possible after signs of exostosis appear, before its active growth provokes deformation of the fingers.