Finger Fracture: Diagnosis, Classification, and Treatment Principles

A finger fracture is a break in one or more phalanges (proximal, middle, distal). Proper management prevents stiffness, malunion, and functional impairment.

Mechanism & Presentation

• Direct trauma (crush, impact), axial load (jammed finger), twisting injury.
• Pain, swelling, deformity, ecchymosis, limited motion, rotational malalignment (scissoring).

Classification (Guides Treatment)

• By bone: Distal phalanx (tuft, shaft, base) > middle > proximal.
• By pattern: Transverse, oblique, spiral, comminuted, intra-articular (condylar, basilar).
• By stability: Stable (non-displaced, impacted) vs. unstable (displaced, shortened, rotated, comminuted).
• Open vs. closed: Open = soft tissue laceration communicating with fracture (Gustilo classification).

Treatment Principles

Fracture Type	Typical Management
Non-displaced, stable	Buddy taping (to adjacent finger) + early motion; splint 2–3 weeks if needed
Displaced, reducible, stable after reduction	Closed reduction + splinting (3–4 weeks) with weekly X-rays
Unstable, irreducible, intra-articular, open	ORIF (K-wires, mini-plates, screws); external fixation for severe soft tissue injury
Distal phalanx tuft	Protective splint/orthosis; nail bed repair if subungual hematoma >50% or laceration
Mallet finger (extensor avulsion)	Continuous DIP extension splint 6–8 weeks
Jersey finger (FDP avulsion)	Surgical repair within 7–10 days

Rehabilitation

• Early protected motion (after 1–2 weeks for stable) to prevent stiffness.
• Edema control (elevation, compression, retrograde massage).
• Progressive ROM → strengthening → functional tasks.
• Hand therapy referral for complex injuries.

Red Flags for Urgent Referral

• Open fracture, neurovascular compromise, rotational deformity, >2 mm articular step-off, multiple fractures, child with physeal involvement.

Even "minor" finger fractures can cause permanent stiffness or deformity if mismanaged. Early specialist evaluation optimizes hand function.