Phalangeal Fractures

Proximal, Middle, and Distal Phalangeal Fractures

Overview

Phalangeal fractures are breaks or cracks in the bones of the fingers, known as phalanges. Every finger has three phalanges (proximal, middle, and distal). The thumb only has two. These fractures are common and can occur due to direct trauma or accidents such as falls or crush injuries. Phalangeal fractures vary in severity, ranging from simple fractures that heal easily to more complicated types that require surgical intervention.

Anatomy of the Finger: Understanding the Phalanges

Each finger consists of three bones called phalanges:

  • The proximal phalanx: This is the bone closest to the hand, connecting the finger to the metacarpal bones.
  • The middle phalanx: This is the bone in the middle of the finger (absent in the thumb).
  • The distal phalanx: This is the bone at the tip of the finger, often involved in injuries such as crush or nail-bed injuries.

These bones are connected by joints (interphalangeal joints), surrounded by tendons and ligaments that provide stability and movement.

Types of Phalangeal Fractures

  1. Simple Fracture: This is when there is a single crack in the bone that usually remains well-aligned. These fractures are often stable and can heal with immobilisation or minimal intervention.
  2. Comminuted Fracture: This is described when the bone is broken into multiple pieces. These fractures are typically the result of high-impact trauma and may require surgical fixation to restore proper alignment and function.
  3. Intra-articular Fracture: This is when the fracture extends into the joint surface. These can be particularly serious because they affect the smooth functioning of the joint, and improper healing may lead to arthritis or long-term stiffness.

Prevalence of Phalangeal Fractures in Different Populations

Phalangeal fractures are common in both the general population and specific groups. The prevalence varies based on occupation, activity level, and age:

  • Occupational Injuries: People working with heavy machinery, in construction, or in manual labour are at higher risk of finger fractures, particularly crush injuries involving the distal phalanx.
  • Sports Injuries: Athletes, especially those in contact sports (football, basketball, etc.) or high-speed sports (skiing, cycling), frequently suffer from phalangeal fractures, often in the form of jammed fingers or hyperextension injuries.
  • Children: In children, the bones are still developing, and phalangeal fractures often occur due to falls or playground injuries. These fractures tend to heal more quickly in children than in adults.
  • Elderly: In older adults, fractures can result from weaker bones (osteoporosis) and slower healing. Even minor trauma can lead to fractures in this population.

Understanding the types and prevalence of phalangeal fractures can help guide treatment approaches and prevention strategies across different populations.

Symptoms and Causes of Phalangeal Fractures

Phalangeal fractures in the fingers can arise from various forms of trauma and are often associated with specific signs and symptoms. Understanding the causes, risks, and potential complications is important for prompt diagnosis and treatment.

Common Causes of Proximal, Middle, and Distal Phalangeal Fractures

  1. Proximal Phalanx Fractures:
    1. It is typically caused by direct trauma, such as a blow to the finger during sports or a fall onto an outstretched hand.
    2. Can also occur in accidents involving machinery or while engaging in manual labour, especially in jobs involving heavy tools.
  2. Middle Phalanx Fractures:
    1. Often, the result is a crush injury, such as jamming a finger between two objects.
    2. It can occur from direct impact during sports activities (e.g., catching a ball wrong) or falls.
  3. Distal Phalanx Fractures:
    1. It is frequently caused by crush injuries or blows to the tip of the finger, such as getting fingers caught in a door or hitting the fingertip with a hammer.
    2. It is also common in sports when the fingertip strikes a hard surface, leading to fractures and nail-bed injuries.

Risk Factors for Phalangeal Fractures

  • Occupation: Workers in construction, heavy machinery, and manual labour jobs are more likely to experience finger fractures due to high-impact or crush injuries.
  • Sports: Athletes, especially those involved in contact sports (e.g., football, basketball) or fast-paced activities (e.g., skiing, cycling), are at a higher risk.
  • Age:
    • Children are more prone to fractures due to falls and play-related injuries.
    • Older adults have a higher risk of fractures due to weakened bones (osteoporosis) and reduced coordination, making falls more likely.
  • Bone Health: Individuals with osteoporosis, poor bone density, or chronic health conditions may be more prone to fractures from relatively minor trauma.
  • Repetitive Stress: Repetitive use of the fingers (e.g., typing, manual work) can weaken the bones or lead to micro-injuries over time, increasing fracture risk.

Signs and Symptoms of Phalangeal Fractures

  • Pain: Intense, sharp pain at the site of the fracture, particularly when moving the affected finger.
  • Swelling: Swelling often occurs rapidly around the injured area; in some cases, bruising or discolouration can develop.
  • Deformity: In more severe fractures (comminuted or displaced fractures), the finger may appear misshapen or bent in an unnatural position.
  • Inability to Move: Stiffness or inability to move the finger or joint is common, especially in intra-articular fractures that affect joint function.
  • Tenderness: The finger may feel tender to the touch; even light pressure can cause significant discomfort.
  • Nail Deformities: In distal phalanx fractures, nail or nail bed damage can occur, leading to discolouration or detachment of the nail.
  • Visible Wounds: In open fractures, where the bone pierces the skin, there will be a visible wound with bleeding.
Phalangeal Fracture
Inability to bend or straighten finger may indicate a phalangeal fracture

Potential Complications of Untreated Phalangeal Fractures

  • Malunion: Without proper treatment, the bones may heal incorrectly, leading to a deformed finger. This can cause long-term functional issues, pain, and reduced range of motion.
  • Non-union: In some cases, the bones may fail to heal altogether, resulting in chronic pain and weakness in the finger.
  • Joint Stiffness: Untreated intra-articular fractures (those affecting the joints) may lead to permanent stiffness in the finger, limiting movement and flexibility.
  • Arthritis: If the fracture involves a joint and does not heal properly, it can increase the risk of developing osteoarthritis in the affected finger.
  • Nerve or Vascular Damage: In severe or displaced fractures, nearby nerves or blood vessels may be injured, leading to numbness, tingling, or compromised blood flow to the finger.
  • Chronic Pain: Improperly healed fractures may result in chronic pain, particularly during movement or when pressure is applied to the affected finger.
  • Infection: Open fractures, where the skin is broken, can lead to infections in the bone (osteomyelitis) if not treated with appropriate wound care and antibiotics.

Early diagnosis and appropriate treatment of phalangeal fractures are critical to avoid these complications and ensure proper healing. Treatment may range from splinting or casting to surgery.

Access Ortho are specialists in orthopaedic injuries. They will assess and treat your fracture rapidly, helping to minimise potential complications.

Diagnosis and Tests for Phalangeal Fractures

Diagnosing phalangeal fractures requires a combination of physical examination and imaging techniques to determine the injury’s location, type, and severity. Early diagnosis is essential to ensure appropriate treatment and to prevent long-term complications. Access Ortho offers rapid appointments for acute orthopaedic injuries. 

How are Phalangeal Fractures Diagnosed?

Phalangeal fractures are diagnosed through a thorough medical evaluation that includes the patient’s history, physical examination, and imaging studies.

  1. Medical History:
    1. The medical practitioner will ask the patient how the injury occurred, the severity of the impact, and any immediate symptoms (such as pain, swelling, or deformity).
    2. The patient’s occupation, activities (e.g., sports), and any prior finger injuries will be discussed to assess potential risks or complications.
    3. We will also review any underlying conditions that may affect bone healing, such as osteoporosis.
  2. Physical Examination:
    1. The doctor will visually inspect the injured finger for signs of deformity, swelling, or open wounds.
    2. They will gently palpate (touch) the affected area to locate points of tenderness, assess the range of motion, and check for potential deformities or instability.
    3. Tendons, ligaments, and joint stability are also evaluated to identify any additional soft tissue damage.
    4. Special tests may be performed to assess nerve function or circulation, such as checking for sensation and capillary refill (a test of blood flow).

Imaging Techniques Used for Phalangeal Fractures

  1. X-rays:
    • Primary diagnostic tool: X-rays are the most commonly used imaging technique to diagnose phalangeal fractures. They can clearly show the finger’s bones, allowing the doctor to assess the location and severity of the fracture.
    • Assessment of fracture type: X-rays can reveal different types of fractures, such as simple, comminuted, or intra-articular, and whether the fracture is stable or unstable.
  2. CT Scans (Computed Tomography):
    • Detailed bone structure: CT scans provide more detailed images of the bones than X-rays. They are helpful in assessing complex fractures, especially those that are comminuted (multiple fragments) or involve the joints (intra-articular fractures).
    • 3D reconstruction: In some cases, CT scans can create 3D images of the bone, allowing for a better understanding of the fracture pattern, which is helpful for surgical planning.
    • Use in severe cases: CT scans are usually reserved for cases where X-rays don’t provide enough detail or when a more complex fracture is suspected.
  3. MRI (Magnetic Resonance Imaging):
    • Soft tissue evaluation: While not commonly used to diagnose simple fractures, MRI can be useful in cases where there is concern about damage to surrounding soft tissues, such as tendons, ligaments, or nerves, that may not be visible on X-rays or CT scans.

Physical Examination Procedures for Assessing Phalangeal Injuries

  1. Inspection:
    • The doctor will examine the finger, checking for any obvious deformities, discolouration, swelling, or wounds.
    • If the finger appears misaligned or bent at an abnormal angle, this can indicate a displaced fracture.
  2. Palpation:
    • Gentle pressure is applied to the injured finger to locate areas of tenderness or sharp pain, which helps pinpoint the fracture site.
    • The doctor will also feel for any crepitus (a grinding or crackling sensation), which may indicate broken bone fragments moving against each other.
  3. Range of Motion Testing:
    • The patient will be asked to bend and straighten the affected finger, if possible. Limited movement, pain during movement, or an inability to fully extend or flex the finger can indicate the presence of a fracture or associated joint damage.
    • In intra-articular fractures, movement may be severely restricted.
  4. Circulatory and Nerve Function Tests:
    • The doctor may assess circulation by checking capillary refill, which involves pressing on the fingertip to see how quickly blood returns to the area. Delayed refill may indicate compromised blood flow.
    • Nerve function is assessed by testing sensation in the finger. The patient may be asked if they feel numbness or tingling, which could suggest nerve damage.
    • Strength tests, like having the patient grasp an object or resist force, may also be used to check for muscular or tendon involvement.

Access Ortho is a private fracture clinic in Brisbane and Ipswich offering urgent appointments with specialists in orthopaedic care.

Management and Treatment of Phalangeal Fractures

Treatment for phalangeal fractures depends on the fracture’s severity, type, and location. Some fractures can heal with conservative management, while others may require surgery to restore proper alignment and function.

Conservative Treatment Options for Phalangeal Fractures, including casting and splinting

  1. Rest and Immobilisation:
    • Simple, non-displaced fractures can often be treated with rest and immobilisation, allowing the bones to heal without surgical intervention.
    • Immobilisation is key to preventing movement of the fractured bone, ensuring that it heals properly in alignment.
  2. Buddy Taping:
    • For minor, stable fractures, buddy taping (taping the injured finger to an adjacent finger) is a common conservative approach.
    • This technique stabilises the injured finger while allowing some movement of both fingers. It can be effective for non-displaced fractures or stable fractures of the distal phalanx.
  3. Splinting:
    • Splints are used to immobilise the affected finger in a neutral or slightly bent position to maintain proper alignment while the bone heals.
    • Aluminium foam splints are often used to support fractures in the distal phalanx, while other types of splints may be applied to proximal or middle phalanx fractures.
    • Splints are worn for several weeks (typically 3-6 weeks), depending on the severity of the fracture.
  4. Casting:
    • A cast may be applied in cases where more support is needed, particularly for fractures in the proximal or middle phalanges that require immobilisation of the whole finger or even the hand and wrist.
    • A cast provides more rigid support than a splint and is used for more severe but non-surgical fractures.
Finger splint used to immobilise a phalangeal fracture

Surgical Interventions for Complex Phalangeal Fractures

  1. Open Reduction and Internal Fixation (ORIF):
    • ORIF is the most common surgical intervention for displaced or complex phalangeal fractures, particularly comminuted fractures.
  2. External Fixation:
    • In cases where the fracture is too unstable or involves extensive soft tissue damage, external fixation may be used. This involves the use of pins inserted through the skin and into the bone, held in place by an external frame.
    • External fixation is less common but may be used for severe open fractures or fractures with extensive soft tissue involvement.
  3. K-Wires (Kirschner Wires):
    • K-wires are thin metal wires that can be used for temporary fixation of the bone fragments in phalangeal fractures. They are often inserted through the skin (percutaneous) and provide stability until the bone heals.
    • This method is minimally invasive and often used for distal or middle phalanx fractures, especially in children.

Pain Management Strategies for Phalangeal Fractures

  1. Over-the-counter Pain Relievers:
    • Non-steroidal anti-inflammatory drugs (NSAIDs), for example ibuprofen, are commonly recommended to reduce pain and inflammation.
    • Panadol (paracetamol) can also be used for pain relief if NSAIDs are contraindicated.
  2. Cold Therapy:
    • Applying ice packs to the affected finger for 10-20 minutes several times a day during the first 48 hours helps reduce swelling and manage pain.
  3. Elevation:
    • Keeping the injured hand elevated above the level of the heart reduces swelling and discomfort, particularly in the initial stages following injury.
  4. Splinting and Immobilisation:
    • Proper immobilisation of the finger reduces movement-induced pain and provides stability during the healing process.
  5. Prescription Pain Medications:
    • In cases of severe pain or following surgery, stronger prescription pain medications (e.g., opioids) may be prescribed for short-term use.

Rehabilitation Exercises for Phalangeal Fractures

After immobilisation, rehabilitation is crucial to restore strength, flexibility, and movement in the injured finger. Some common exercises include:

  1. Range of Motion Exercises:
    • Finger Flexion and Extension: Start by gently bending and straightening the injured finger to regain movement.
    • Finger Spreading: Spread the fingers apart and bring them back together to improve coordination and flexibility.
  2. Grip Strengthening Exercises:
    • Use a soft ball or therapy putty to gently squeeze and release, which helps rebuild strength in the hand and fingers after a period of immobilisation.
  3. Tendon Gliding Exercises:
    • These exercises are designed to help restore normal tendon movement. You’ll bend the fingers into different positions (fist, hook, straight) to improve tendon flexibility and joint mobility.
  4. Stretching:
    • Gentle stretching of the fingers, focusing on both flexion and extension, helps improve flexibility and prevent stiffness after the immobilisation period.
  5. Resistance Exercises:
    • Using a small rubber band or light resistance putty, stretch and bend the fingers to increase strength and improve fine motor control.

Rehabilitation is typically supervised by a physiotherapist and tailored to the severity of the injury and progress of the healing process. The exercises should be done gradually to avoid re-injury.

Access Ortho will guide you on the best treatment for your injury. 

Prevention of Phalangeal Fractures

Phalangeal fractures can be painful and lead to long-term complications if not treated properly. Fortunately, there are several strategies to reduce the risk of these fractures, particularly for individuals involved in high-risk activities.

Strategies to Prevent Phalangeal Fractures

  1. Avoid High-Risk Activities:
    • Where possible, avoid situations where finger trauma is more likely—for example, be cautious while handling heavy objects or avoid distractions when using power tools or machinery.
    • Individuals involved in contact sports should be aware of the high risk of finger injuries and modify techniques if necessary (e.g., using open-hand tackles in rugby rather than grasping).
  2. Warm-up and Stretching:
    • Warming up before physical activities helps prepare muscles and joints, reducing the risk of injury to the fingers.
    • Stretching the hands and fingers before activities like sports or manual work can help prevent sudden strains that lead to fractures.
  3. Safe Techniques:
    • Learning proper techniques in sports or during physical tasks, such as lifting or using tools, can reduce strain on the hands and fingers, decreasing the chance of injury.
    • Athletes should be taught proper catching, gripping, and handling techniques to avoid jamming or twisting fingers during play.

Proper Hand Protection in Sports and Occupational Settings

  1. Protective Gloves:
    • Sports: Gloves designed for specific sports (e.g., rugby, cricket, or hockey) provide padding and protection against impacts and can reduce the risk of finger injuries.
    • Occupational Settings: Industries such as construction, manufacturing, or heavy machinery should have workers wear well-fitted protective gloves. These gloves can protect against crush injuries, cuts, and impact trauma to the fingers.
  2. Taping and Finger Braces:
    • In sports, athletes can tape their fingers or wear finger braces for added support and to reduce the risk of hyperextension or jamming. This is especially useful for sports like basketball, volleyball, or rock climbing.
    • For individuals prone to finger injuries due to previous fractures or chronic joint instability, taping or splinting during physical activity can provide additional protection.
  3. Ergonomic Tools:
    • Using ergonomically designed tools that reduce strain on the hands and fingers can help prevent fractures in occupational settings. Handles should be cushioned and shaped to fit the hand comfortably.
    • Avoid using tools or equipment that are too large or too small, as improper handling can increase the risk of accidents and injuries.
  4. Workplace Safety Practices:
    • Follow safety protocols and best practices in occupational environments to minimise injury risks. For example, use machine guards and other protective equipment when working with heavy machinery or hazardous tools.
    • Ensure proper training in the use of tools, machinery, and safety equipment to avoid accidental injuries.

Importance of Bone Health in Fracture Prevention: 

Maintain Adequate Calcium and Vitamin D: Ensuring your diet includes both calcium and Vitamin D helps to strengthen bones, especially for individuals at risk, like post-menopausal women or those with osteoporosis. 

Regular Exercise: Weight-bearing and hand-targeted exercises help increase bone density and flexibility, reducing the risk of fractures. Stretching and strength exercises also support joint flexibility and muscle strength. 

Osteoporosis Management: People with osteoporosis are more fracture-prone, so managing bone health through medication, lifestyle changes, and regular bone density screenings (DEXA scans) is crucial. 

Avoid Smoking and Excessive Alcohol: Smoking and excess alcohol use weaken bones, increasing fracture risk. Limiting these habits improves bone health. 

Outlook / Prognosis for Phalangeal Fractures

The prognosis for phalangeal fractures depends on the type and severity of the injury and the effectiveness of the treatment. With proper care, many people fully recover, though some fractures may lead to long-term complications, including arthritis.

Expected Recovery Time for Different Types of Phalangeal Fractures

  1. Simple, Non-displaced Fractures:
    • Recovery time: 3 to 6 weeks.
    • With conservative treatment, such as splinting or buddy taping, these fractures typically heal without complications, and full function can usually be regained within 6-8 weeks.
  2. Displaced or Comminuted Fractures:
    • Recovery time: 6 to 12 weeks, depending on the complexity.
    • These fractures may require surgical intervention (e.g., ORIF), and healing time can be longer due to the need for bone realignment and additional rehabilitation.
  3. Intra-articular Fractures:
    • Recovery time: 8 to 12 weeks or more.
    • Fractures involving joint surfaces require careful management to restore joint function and prevent stiffness. Surgery may be necessary, and physiotherapy is essential for long-term recovery.
  4. Distal Phalangeal Fractures (e.g., “Mallet Finger”):
    • Recovery time: 4 to 8 weeks.
    • These fractures are often treated with splints; most heal within a few months. However, residual stiffness or mild deformity is possible.

Long-term Prognosis for Proximal, Middle, and Distal Phalangeal Fractures

  1. Proximal Phalangeal Fractures:
    • Prognosis is generally good with proper treatment, but these fractures can sometimes result in reduced range of motion or grip strength if not fully rehabilitated.
    • Long-term stiffness or malalignment can occur if the fracture doesn’t heal properly.
  2. Middle Phalangeal Fractures:
    • If treated correctly, most patients regain near-normal function. However, these fractures have a moderate risk of stiffness and joint dysfunction, especially if surgery is required.
    • Recovery may take longer than distal fractures due to the central role of the middle phalanx in finger movement.
  3. Distal Phalangeal Fractures:
    • Generally, these fractures have an excellent prognosis with appropriate splinting. However, in some cases, residual deformities, nail bed damage, or chronic pain can persist.

Potential for Arthritis Development Following Phalangeal Fractures

  1. Intra-articular Fractures:
    • Fractures that involve the joints are at the highest risk of post-traumatic arthritis. Damage to the cartilage during the fracture can lead to long-term joint pain and stiffness.
  2. Displaced or Improperly Healed Fractures:
    • If a fracture heals in a misaligned position, it can alter the biomechanics of the finger joints, increasing wear on the cartilage and leading to arthritis over time.
  3. Comminuted Fractures:
    • The multiple bone fragments in comminuted fractures can increase the likelihood of uneven healing, contributing to joint instability and arthritis later in life.

Preventive Measures for Arthritis:

  • Early intervention and proper alignment during fracture treatment help reduce the risk of arthritis.
  • Physiotherapy is crucial to maintain joint flexibility and strength.
  • Long-term follow-up may be needed to monitor for early signs of arthritis in more severe cases.

Access Ortho offers Urgent Care for musculoskeletal injuries such as fractures, sprains and strains. 

When to Seek Medical Attention for Phalangeal Fractures

Timely medical attention is crucial for proper healing of phalangeal fractures. Delayed treatment can increase risk of complications, such as poor bone alignment, joint stiffness, or long-term disability. Access Ortho is a private fracture clinic offering urgent appointments for acute injuries. 

Signs To Watch for that Indicate the Need for Immediate Medical Care

  1. Severe Pain and Swelling:
    • If pain is intense and doesn’t improve with rest, ice, or over-the-counter pain relievers, immediate care is needed.
    • Swelling, especially if it is accompanied by deformity or abnormal finger positioning, suggests a more serious fracture.
  2. Visible Deformity:
    • A finger that looks crooked, bent at an unusual angle, or has visible bone protrusion indicates a displaced or severe fracture that requires urgent medical attention.
  3. Numbness or Tingling:
    • Loss of sensation, numbness, or pins and needles in the injured finger or surrounding areas may indicate nerve damage, which needs prompt evaluation.
  4. Inability to Move the Finger:
    • If the injured finger cannot be moved or bent, it may signal a significant fracture or tendon injury that requires immediate intervention.
  5. Open Wounds:
    • If the skin is broken and the fracture is exposed (open or compound fracture), immediate care is required to prevent infection and ensure proper bone healing. Seek medical attention for this at your nearest hospital emergency department.
  6. Bruising or Discolouration:
    • Severe bruising or discolouration, especially if accompanied by other symptoms like swelling or deformity, may indicate a more complex fracture or underlying vascular injury.
  7. Signs of Infection (for previously treated fractures):
    • If an injured finger becomes red, warm to the touch, or begins to drain pus after initial treatment, it may indicate an infection that requires immediate attention.

Follow-up Appointments and Monitoring for Phalangeal Fractures

  1. Regular X-rays and Imaging:
    • Follow-up X-rays may be required to monitor the healing progress, especially for displaced, comminuted, or intra-articular fractures.
    • For complex fractures or post-surgical cases, additional imaging (such as CT scans) may be used to ensure proper alignment and healing.
  2. Splint or Cast Check-ups:
    • Regular follow-up appointments are necessary to adjust or remove splints, casts, or other immobilisation devices. Improper fit or prolonged immobilisation can lead to stiffness or further complications.
  3. Monitoring for Complications:
    • Patients require monitoring for signs of complications, such as non-union (where the fracture doesn’t heal) or malunion (where the bone heals in an incorrect position). Early detection can lead to interventions to correct these issues.

Access Ortho provides follow-up care with orthopaedic surgeons in clinic until a full recovery is made. If surgery is required, Access Ortho will assist in finding a surgeon suitable for your injury. 

Understanding Fracture Clinics

What is a fracture clinic?

A fracture clinic such as Access Ortho is a specialised medical clinic that focuses on diagnosing, treating, and following up on bone fractures and musculoskeletal injuries. Access Ortho Fracture Clinic is staffed by orthopaedic surgeons, emergency physicians, and orthopaedic nurse practitioners who are specialists in managing the recovery process for individuals with broken bones or joint injuries.

Access Ortho is an Urgent Care centre that only treats orthopaedic injuries. Our staff specialise in orthopaedic care, ensuring injuries are treated by practitioners trained in orthopaedics. 

At Access Ortho fracture clinic, patients receive ongoing care in specialist clinics after the initial emergency or urgent treatment of their injury. The clinic ensures proper healing, monitors for complications, and provides rehabilitation guidance.

When should you visit a fracture clinic for a phalangeal fracture?

You should visit a fracture clinic such as Access Ortho in the following situations:

  • After a finger injury:

You may attend Access Ortho Fracture as your first point of contact following a finger injury. The orthopaedic team will assess your injury and arrange radiology if required before outlining a treatment plan. Access Ortho will cast/splint your finger if required and arrange orthopaedic follow-up care. Access Ortho will help diagnose the type of injury you have.

  • After Initial Treatment of a Phalangeal Fracture:

If you’ve been treated for a phalangeal fracture in an emergency department or by your general practitioner, you may attend the fracture clinic for ongoing care and monitoring. You do not need a referral to come to Access Ortho.

What to expect during a fracture clinic appointment for a phalangeal fracture

During your visit to a fracture clinic, the appointment will generally include the following steps:

Medical History and Symptom Review:

The medical practitioner will ask about your injury, current symptoms (e.g., pain, swelling, stiffness), and how well you’ve recovered since your initial treatment.

Physical Examination:

Your finger will be examined for swelling, alignment, tenderness, range of motion, and any visible deformities or complications. If immobilisation devices like splints or casts are still in place, the doctor may assess their fit or remove them for a closer examination.

Imaging (X-rays or Other Scans):

Follow-up imaging is often used to check the progress of bone healing. This may include X-rays or, in some cases, CT scans or MRIs, especially if the injury involves joint damage or surgical repairs.

Discussion of Treatment Plan:

Based on the assessment findings and imaging results, the orthopaedic team will discuss whether any further treatment is needed, such as:

  • Continuing immobilisation (splints, casts, etc.).
  • Starting rehabilitation exercises to regain finger strength and flexibility.
  • Surgery if complications arise (e.g., malunion or non-union of the bone).

Rehabilitation Guidance:

  • The clinic may refer you to a physiotherapist or provide instructions for rehabilitation exercises to improve your finger’s mobility and function.

Monitoring for Complications:

The specialist will check for signs of complications such as infection, poor healing, or nerve/tendon damage. If any issues are found, further treatment options will be discussed. 

Fracture clinics / Urgent Care Centres such as Access Ortho play a key role in ensuring a successful recovery from phalangeal fractures. They provide medical care to help restore normal hand function. Access Ortho is one of Brisbane’s leading fracture clinics, providing specialist care for fractures, dislocations, sprains, and strains.

Commonly Asked Questions

How can I tell if my finger is broken or just bruised?

A broken finger typically involves severe pain, swelling, and sometimes a visible deformity. You may have difficulty moving the finger, and it could appear crooked or bent at an unusual angle. A bruised finger, on the other hand, often presents with pain and discolouration, but the pain is usually less intense, and the finger can often still move.

If symptoms persist, it is important to get medical advice.

Can I move my finger if it has a phalangeal fracture?

It is possible to move your finger with a phalangeal fracture, especially if it’s a non-displaced or hairline fracture. However, movement is often painful and limited. If you suspect a fracture, you need to seek medical attention, as movement could worsen the injury.

How long does it take for a phalangeal fracture to heal completely?

Healing time varies depending on the fracture. Most simple phalangeal fractures heal in 3 to 6 weeks. More complex fractures, such as displaced or intra-articular fractures, can take 6 to 12 weeks or longer, especially if surgery is required.

Will I need surgery for my phalangeal fracture?

Surgery is required for severe fractures, such as displaced, comminuted, or intra-articular fractures, where bones need to be realigned. Simple, non-displaced fractures often heal with conservative treatments like splints or buddy taping.

What’s the difference between proximal, middle, and distal phalangeal fractures?

The proximal phalanx is closest to the hand, the middle phalanx is in the centre, and the distal phalanx is at the tip of the finger. Fractures can occur at any of these locations, with proximal fractures typically involving more complex movement issues, while distal fractures (e.g., mallet finger) are more common but may heal quicker.

How soon can I return to work after a phalangeal fracture?

Return to work depends on your job requirements and the severity of the fracture. For desk-based jobs, you may return in 1 to 2 weeks, using a splint. For manual labour jobs or activities that require full hand function, it might take 6 to 12 weeks. Consult your doctor for tailored advice.

Can a phalangeal fracture heal on its own without treatment?

Fractures need treatment to heal properly. Even if a fracture seems minor, improper healing can result in malalignment, reduced function, or long-term complications like arthritis. It is therefore important to get medical attention for all injuries.

Will my finger look different after it heals from a phalangeal fracture?

In some cases, particularly with severe or improperly healed fractures, there may be a slight deformity or thickening of the bone. However, with appropriate treatment and rehabilitation, many patients regain near-normal appearance and function.

How can I manage swelling in my finger with a phalangeal fracture?

Rest, ice, compression, and elevation are key. Apply ice for 20 minutes every few hours during the first few days. Keep the hand elevated to reduce swelling, and follow medical advice regarding splinting or casting.

Are there any exercises I can do to assist with my recovery from a phalangeal fracture?

Hand and finger exercises are important for recovery after immobilisation. Gentle range-of-motion exercises (such as making a fist, bending and straightening the fingers) and strengthening exercises (squeezing a stress ball) can improve flexibility and prevent stiffness. Always consult with your doctor or physiotherapist before starting exercises.