Understanding Phalangeal Dislocations and Fractures

Overview of Phalangeal Dislocations and Fractures

Phalangeal dislocations and fractures refer to injuries to the bones and joints of the fingers. These injuries are common in sports, accidents, and everyday activities and range from mild to severe. Understanding these types of injuries is essential to ensure proper treatment and rehabilitation.

Anatomy of the Finger: Phalanges and Joints

Each finger (excluding the thumb) consists of three bones called phalanges:

• Proximal Phalanx: This is the bone in the finger closest to the hand.
• Middle Phalanx: The bone between the proximal and distal phalanges.
• Distal Phalanx: The tip of the finger.

The thumb has two phalanges: It only has proximal and distal phalange. 

These phalanges connect through three primary joints:

• Metacarpophalangeal Joint (MCP): Connects the hand to the proximal phalanx.
• Proximal Interphalangeal Joint (PIP): Connects the proximal phalanx to the middle phalanx.
• Distal Interphalangeal Joint (DIP): Connects the middle phalanx to the distal phalanx.

Each joint is stabilised by ligaments and tendons, allowing the finger to bend and flex while maintaining stability.

Types of Phalangeal Injuries: Dislocations vs. Fractures

• Phalangeal Dislocations

Dislocations occur when the bones making up a joint are moved out of their normal alignment due to forces applied. In the fingers, dislocations are most common at the PIP joint but can also occur at the MCP and DIP joints. Dislocations typically happen due to a sudden force applied to the finger, causing the bones to slip out of place.

• Phalangeal Fractures

Fractures, or breaks, in the phalanges, can occur in any of the finger bones and may be classified as:

1. Simple Fractures: The bone breaks but remains in alignment.
2. Comminuted Fractures: The bone is shattered into multiple fragments.
3. Open (Compound) Fractures: The bone pierces through the skin, posing a higher risk of infection.
4. Intra-articular Fractures: The fracture extends into the joint, which can complicate healing.

Both dislocations and fractures can cause pain, swelling, and limited motion. Proper diagnosis and management are required to prevent long-term stiffness or deformity.

How Common are Phalangeal Dislocations and Fractures?

Phalangeal dislocations and fractures are common injuries, especially in sports like basketball, football, and skiing, where fingers are susceptible to impact and twisting forces. Phalangeal fractures make up a large proportion of hand injuries, with some studies indicating that they represent over 40% of all fractures in the hand. Phalangeal dislocations are also frequent, with PIP joint dislocations being particularly common due to the joint’s vulnerability.

Symptoms and Causes

Symptoms and Causes of Phalangeal Dislocations and Fractures

Common Causes of Phalangeal Dislocations and Fractures

Phalangeal dislocations and fractures commonly occur due to:

• Direct Trauma: Impact from sports, falls, or accidents.
• Hyperextension or Twisting: Sudden bending or twisting forces, especially in activities involving gripping or catching.
• High-Impact Collisions: Common in contact sports or heavy manual work.

Risk Factors for Finger Injuries

Certain factors can increase the likelihood of finger injuries, including:

• Participation in Contact Sports: Basketball, football, and martial arts increase exposure to impact and twisting forces.
• Repetitive Hand Use: Manual labour, weightlifting, and racket sports.
• Bone or Joint Conditions: Conditions like osteoporosis or arthritis may weaken bones and joints.

Signs and Symptoms of Phalangeal Dislocations and Fractures

Signs and symptoms may include:

• Pain and Swelling: Localised pain and swelling, often accompanied by bruising.
• Deformity or Misalignment: Dislocated or fractured bones may cause visible deformity.
• Limited Range of Motion: Inability to move the finger fully.
• Numbness or Tingling: Often due to nerve compression from the injury.

Potential Complications of Untreated Finger Injuries

Untreated phalangeal injuries can lead to complications, including:

• Joint Stiffness or Deformity: Reduced motion or finger deformity due to improper healing.
• Chronic Pain or Arthritis: Persistent pain or early-onset arthritis if the joint is affected.
• Weak Grip Strength: Loss of function due to compromised joint or ligament stability.

Prompt diagnosis and establishment of a treatment plan are important to prevent long-term complications. Access Ortho is an Urgent Care Fracture Clinic offering rapid appointments for fractures and dislocations. 

Diagnosis and Tests

Diagnosis and Tests for Phalangeal Dislocations and Fractures

Diagnosis of Phalangeal Dislocations and Fractures

Phalangeal dislocations and fractures are diagnosed through physical examination and imaging tests. Access Ortho will carry out the required physical examination and arrange for radiology to help diagnose finger injuries. 

Imaging Tests for Finger Injuries

• X-rays: Standard imaging to confirm fractures or dislocations and assess the injury’s severity.
• CT Scans: Used for complex or comminuted fractures, particularly those affecting joints.
• MRI: Occasionally used to evaluate ligament or tendon damage if soft tissue injury is suspected.

Physical Examination Techniques

During a physical exam, the medical practitioner will:

• Inspect for Deformity, Swelling, and Bruising: Checking for visible signs of injury.
• Assess Range of Motion and Stability: Testing the movement and stability of the affected joint.
• Evaluate Neurovascular Function: Checking circulation, sensation, and nerve function to ensure no nerve or blood vessel damage.

These methods help determine the exact injury type and guide the treatment plan.

Access Ortho is staffed by specialists in orthopaedic care. Our team will assess your injury and establish a treatment plan. 

Specific Considerations

Specific Considerations for Phalangeal Dislocations and Fractures

Differences Between Phalangeal Dislocations and Fractures

• Dislocations: Involve a joint where bones are forced out of alignment, often without bone damage. Dislocations may require reduction (repositioning) but generally do not involve breaks in the bone.
• Fractures: Involve a break in the bone itself and can range from simple cracks to complex shattering. Depending on their severity, fractures may need immobilisation or surgery.

Impact of Finger Injuries on Hand Function and Daily Activities

Finger injuries can significantly impact hand function, affecting grip strength, dexterity, and fine motor skills. If untreated, this can interfere with everyday activities like typing, holding objects, and personal care tasks, leading to reduced independence and productivity.

Associated Soft Tissue Injuries in Phalangeal Dislocations and Fractures

Phalangeal injuries often involve ligament sprains, tendon damage, and nerve or blood vessel injuries. If not managed properly, these associated soft tissue injuries can complicate healing and increase the risk of long-term joint stiffness, pain, and reduced finger mobility.

Access Ortho offers specialist orthopaedic care for musculoskeletal injuries such as fractures and dislocations. Access Ortho offers rapid appointments.

Management and Treatment

Management and Treatment of Phalangeal Dislocations and Fractures

General Treatment Approaches for Phalangeal Dislocations and Fractures

Treatment varies depending on the specific injury, but generally includes:

• Reduction: Repositioning dislocated bones or fractured fragments, often performed manually.
• Immobilisation: Stabilising the finger with splints, casts, or buddy taping to aid healing.

Conservative vs. Surgical Treatment Options

• Conservative Treatment: Involves non-surgical approaches, typically for stable fractures and uncomplicated dislocations. This includes splinting, buddy taping, and physical therapy.
• Surgical Treatment: Necessary for complex, displaced, or open fractures and severe dislocations. Procedures may involve fixation with pins, plates, or screws to realign and stabilise the bone.

Immobilisation Methods for Finger Injuries

• Splints: Commonly used to keep the finger in a stable position.
• Buddy Taping: Taping of the injured finger to an adjacent finger for additional support.
• Casting: Used for more extensive injuries or fractures requiring full immobilisation.

Access Ortho has splinting options in the clinic. On occasion, a referral to a hand therapist to make a custom splint may need to be arranged.

Pain Management Strategies

Pain is managed with:

• Medications: NSAIDs for pain and inflammation; sometimes stronger pain relief is needed post-surgery.
• Ice Application: Reduces swelling and pain in acute stages.
• Elevation: Helps decrease swelling and discomfort.

Rehabilitation and Physiotherapy for Phalangeal Injuries

Physiotherapy is essential to restore strength, range of motion, and flexibility. Rehabilitation may include:

• Range of Motion Exercises: Gradually improving mobility.
• Strengthening Exercises: Enhancing grip strength and finger function.
• Stretching and Flexibility Work: To reduce stiffness and prevent contractures.

Rehabilitation can last weeks to months, depending on the severity of the injury. If hand therapy is required, Access Ortho will write a referral for this. 

Prevention

Prevention of Phalangeal Dislocations and Fractures

Strategies to Prevent Phalangeal Dislocations and Fractures

• Technique Awareness: Use proper hand positioning and technique in sports and activities to minimise risk.
• Strength and Flexibility Exercises: Regular exercises to strengthen hand and finger muscles and improve joint flexibility can reduce injury risk.

Proper Hand Protection in Various Activities

• Sports Gear: Wear protective gloves or tape fingers for sports like basketball, football, and martial arts.
• Work Equipment: To protect against impact, wear gloves with padding in manual labour, construction, or any work involving heavy machinery.
• Proper Ergonomics: Maintain hand posture when typing or using tools to avoid strain on fingers.

General Tips for Maintaining Hand and Finger Health

• Regular Stretching: Stretch fingers and wrists to keep joints flexible and reduce stiffness.
• Avoid Overuse: Take breaks during repetitive hand activities to prevent strain and injury.

These preventive strategies can help maintain hand health and reduce the likelihood of phalangeal injuries.

Outlook / Prognosis

Outlook / Prognosis for Phalangeal Dislocations and Fractures

General Recovery Timeline for Phalangeal Dislocations and Fractures

• Dislocations: Recovery typically takes 3-6 weeks with immobilisation, followed by rehabilitation.
• Fractures: Simple fractures may heal in 4-6 weeks, while complex fractures or those requiring surgery may take several months to fully recover.

Factors Affecting Healing and Recovery

• Injury Severity and Type: Complex fractures and joint involvement often require longer recovery.
• Age and Overall Health: Younger individuals with good bone density tend to heal faster.
• Treatment Adherence: Consistent immobilisation, following medical advice, and engaging in rehabilitation exercises significantly impact recovery speed and quality.

Long-Term Expectations After a Finger Injury

Most individuals regain full function with proper treatment, though some may experience:

• Reduced Range of Motion or Stiffness: Common in complex injuries or if rehabilitation is delayed.
• Residual Pain or Weakness: May persist, especially in joint or nerve-involved injuries.
• Arthritis Risk: Increased in cases where the injury involved a joint, potentially affecting long-term comfort and mobility.

With early treatment and dedicated rehabilitation, most people can return to daily activities with minimal lasting effects. If you have a finger injury, seek medical care rapidly. Access Ortho is a private fracture clinic in Brisbane and Ipswich offering rapid appointments with our orthopaedic team. Rapid assessment and treatment by knowledgeable medical practitioners will decrease the risk of complications.

When to Seek Medical Attention

When to Seek Medical Attention for Phalangeal Dislocations and Fractures

Signs That Indicate Prompt Medical Care is needed

Seek medical attention promptly if you experience:

• Visible Deformity: A bent or misaligned finger indicates a potential fracture or dislocation.
• Severe Pain and Swelling: Persistent or worsening pain, swelling, or bruising.
• Numbness or Tingling: This may signal nerve damage, especially if the feeling doesn’t improve.
• Open Wound or Bone Exposure requires immediate care to prevent infection. If you have an open wound or bone exposure, you should attend your nearest hospital emergency department.

Follow-up care for Phalangeal Dislocations and Fractures

After initial treatment, follow-up care is essential and may include:

• Regular Check-ups: To monitor healing progress, especially for complex fractures.
• X-Rays: To ensure proper bone alignment during healing.
• Rehabilitation Appointments: Physiotherapy sessions to restore strength and mobility.

Access Ortho offers prompt medical attention and follow-up care, which can help ensure a full recovery and reduce the risk of complications.

Understanding Fracture Clinics

What is a Fracture Clinic?

A fracture clinic is a specialised outpatient clinic that provides assessment, treatment, and follow-up care for bone fractures and related injuries. Staffed by orthopaedic specialists, these clinics offer expertise in managing fractures and optimising recovery.

Unlike Urgent Care Centers and Emergency Departments, a fracture clinic, such as Access Ortho, only treats orthopaedic injuries. Our staff are highly skilled in the immediate and follow-up care of orthopaedic injuries. 

When to Visit a Fracture Clinic for a Finger Injury

You may be referred to a fracture clinic if:

• You have a confirmed or suspected fracture that requires further assessment or treatment.
• Initial treatment doesn’t relieve symptoms or complications arise.
• Follow-up care is needed to monitor healing and ensure proper recovery after you have visited another medical clinic, such as a GP, ED, or Urgent Care.

What to Expect During a Fracture Clinic Appointment

At the clinic, you can expect:

• Assessment and Imaging: Further X-rays or scans may be done to evaluate the fracture’s current state.
• Treatment Plan Adjustment: The orthopaedic team may adjust your treatment, including the type of immobilisation, or discuss surgery if needed.
• Rehabilitation Guidance: You’ll receive advice on exercises, pain management, and follow-up appointments for optimal healing.

Fracture clinics provide a comprehensive approach to managing fractures, ensuring that healing is monitored and adjusted as needed for the best outcome.

Commonly Asked Questions About Phalangeal Injuries

How can I tell if my finger is dislocated or fractured?

Signs of a dislocation include visible deformity, swelling, and pain, often with difficulty moving the finger. Fractures may present with pain, swelling, bruising, and sometimes a bent or shortened appearance if the bone is displaced. Only an X-ray can confirm the exact type of injury.

Can I treat a finger injury at home?

Minor sprains can sometimes be managed at home with rest, ice, compression, and elevation (RICE). However, if there is a deformity, severe pain, or loss of function, medical attention is necessary to rule out a fracture or dislocation. It is important to get an accurate diagnosis of your injury before treating it at home.

How long does it typically take for a finger injury to heal?

Most finger injuries heal in 3-6 weeks. Simple fractures and dislocations typically take around 4-6 weeks, while more complex injuries may require a few months.

Will I need surgery for my phalangeal dislocation or fracture?

Surgery is usually only needed for severe fractures, open fractures, or cases where bones can’t be aligned manually. Dislocations rarely require surgery unless there is associated joint damage.

Can I move my finger if it’s injured?

It’s generally best to avoid moving an injured finger, especially if there is swelling, pain, or deformity. Immobilising the finger helps prevent further damage until a professional assessment can be made.

How soon can I return to normal activities after a finger injury?

Light activities may resume after a few weeks, but full activity often requires 6-8 weeks, depending on the severity of the injury. Consult a healthcare provider for specific advice.

Are finger injuries more common in certain sports or occupations?

Yes, finger injuries are more common in contact sports like basketball, football, and martial arts and in occupations involving manual labour or repetitive hand use, like construction and heavy machinery work.

What should I do immediately after injuring my finger?

Apply ice to reduce swelling, elevate the hand to minimise bruising, and avoid moving the finger. If the injury seems severe, seek medical attention promptly.

Can a phalangeal injury lead to long-term problems?

Without proper treatment, finger injuries can result in joint stiffness, reduced range of motion, chronic pain, or arthritis, particularly if the joint is involved.

How can I manage pain and swelling after a finger injury at home?

Use ice packs (It is best to put them on for 20 minutes on, then off for 20 minutes), keep the finger elevated, and consider over-the-counter pain relievers like NSAIDs to help reduce pain and inflammation.