Classification and Treatment of Finger Injury:

Finger bone fractures are among the most typical bone accidents. Distal phalanx bone accidents signify typical sports and work-related accidents. These fractures are usually caused by crushing injuries they are frequently comminuted.

Salient Features

• Very commonly injured.
• Soft tissue coverage is less.
• In nail bed injuries, hematoma can be seen through the nail bed.

Mechanism of Injury

It is mainly due to direct crush injuries. Indirect forces may result in avulsion injuries.

Classifications

Distal phalangeal fractures are classified into:
1.  Longitudinal (36%)
2.  Transverse
3.  Tuft (63%)
4.  Intra-articular complete fractures.
5.  Basal fractures (18%)

• Dorsal
• Volar

Clinical Features

• Pain
• Swelling
• Tenderness and deformity of the tip of the finger
• Loss of function of the distal IP joints is seen

Radiograph

Plain X-ray of the finger AP, lateral and oblique views help to make the diagnosis.

Treatment

Three modalities of treatment are described namely:

Conservative Method: This is reserved mainly for undisplaced, longitudinal and tuft fractures. The method employed is splinting for 3 to 4 weeks.

Closed Reduction and Percutaneous Fixation:
This is reserved for:

• Transverse shaft fractures where external splinting fails to hold the fragments.
• Dorsal base fractures with > 25 percent involvement of articular surfaces. Here the K- wire pinning should be done across the DIP joint.

Open Reduction and Internal Fixation:
This is indicated in:

• Volar base fractures with disruption of the flexor digitorum profundus (FDP) insertion.
• Dorsal base fractures with 30 to 40 percent involvement of the articular surface.

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