Fracture of the Finger (Broken Finger)

First aid for a suspected broken finger

1. Remove rings right away, before swelling makes it impossible.
2. Apply ice wrapped in a cloth for 15 to 20 minutes every 1 to 2 hours for the first day.
3. Raise your hand above heart level to limit swelling.
4. Support the finger: tape it gently to the neighboring finger with padding between them, or use a simple splint, unless it is bent or rotated.
5. Pain relief: acetaminophen (paracetamol) or ibuprofen at the label dose.
6. Do not try to straighten a deformed finger yourself.

Signs that a finger may be broken

• Pain and tenderness directly over the bone
• Swelling and bruising
• Difficulty bending or straightening the finger
• Visible deformity: a bend, shortening or bump
• Rotation: when you make a fist, the injured finger crosses over or points away from the others
• Numbness or tingling
• A cracking sound at the time of injury

A sprain or dislocation can look similar, so an X-ray is usually needed.

Types of broken fingers

By bone

Each finger has three phalanges (the thumb has two):

By pattern

• Non-displaced: the bone is cracked but in position. Usually treated with splinting.
• Displaced: the pieces are out of line and may need realignment.
• Rotated: the fragment twists, causing the finger to cross over others. Needs correction.
• Intra-articular: the break extends into a joint, with higher risk of stiffness and arthritis.
• Avulsion fracture: a small piece of bone is pulled off by a tendon or ligament, as in mallet finger, jersey finger or volar plate injuries.
• Comminuted: the bone is broken into several pieces, often from crush injuries.
• Open (compound): the skin is broken over the fracture, with a risk of infection.

Fingertip and nail injuries

A crushed fingertip often fractures the tuft of the distal bone and causes a painful collection of blood under the nail (subungual hematoma). A clinician can release the pressure through a small hole in the nail. See fingertip injury.

Diagnosis

A clinician checks the finger's alignment, rotation, movement, tendon function, circulation and sensation. X-rays in several views confirm the fracture and show displacement and joint involvement. CT is occasionally used for complex joint fractures.

Treatment

Non-surgical treatment

Most finger fractures are stable and heal well with:

• Buddy taping to the adjacent finger
• Splints: aluminum foam, custom thermoplastic, or a mallet splint for fingertip fractures
• Closed reduction: a displaced fracture is realigned after a numbing injection, then splinted

Splints are usually worn for 3 to 4 weeks. Mallet finger splints are worn continuously for 6 to 8 weeks.

Surgery

Surgery may be needed for:

• fractures that are unstable or cannot be held in position
• rotated fractures
• fractures involving a large part of a joint surface
• open fractures
• multiple fractures

Options include pins (K-wires), small screws or plates. Open fractures need cleaning and antibiotics.

Rehabilitation

Fingers stiffen quickly when immobilized. Hand therapy and exercises usually start as soon as the fracture is stable, often within 3 weeks, to restore motion and strength.

How long does a broken finger take to heal?

• Bone healing: about 3 to 6 weeks
• Return to light use: often 3 to 4 weeks
• Return to contact sports: usually 6 to 8 weeks, with protective taping or splinting
• Full recovery of motion and strength: may take 2 to 3 months or more, especially with joint fractures

Complications

• Stiffness, the most common problem
• Malunion: healing in a bent or rotated position
• Nonunion (rare)
• Post-traumatic arthritis in joint fractures
• Nail deformity after fingertip injuries
• Infection after open fractures
• Chronic swelling or cold sensitivity

Frequently asked questions

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

A jammed finger usually has mild swelling and you can still move it. A broken finger tends to have more severe pain over the bone, significant swelling and bruising, difficulty moving, and sometimes a visible bend or rotation. An X-ray is the only way to be sure.

What are the types of broken fingers?

Finger fractures are described by the bone involved (fingertip, middle or base phalanx) and pattern: non-displaced, displaced, rotated, intra-articular (into a joint), avulsion (a tendon or ligament pulls off a bone fragment), comminuted and open fractures.

Can a broken finger heal on its own?

A minor, non-displaced fracture often heals with buddy taping or a splint. But displaced, rotated or joint fractures can heal crooked or stiff without proper treatment, so a broken finger should always be checked with an X-ray.

How long does it take for a broken finger to heal?

The bone usually heals in 3 to 6 weeks. Light use is often possible after 3 to 4 weeks. Full motion and strength may take 2 to 3 months or longer, particularly if the joint was involved.

Do I need surgery for a broken finger?

Most broken fingers do not need surgery. Surgery is used when the fracture is unstable, rotated, significantly displaced, involves a large part of a joint, or is an open fracture with the skin broken.