First aid for finger fractures and dislocations
Fractures and dislocated fingers are common injuries, especially in contact and ball sports.
Injuries to the fingers can result in significant loss of hand function. Even the simple ‘trapped’ finger, if not diagnosed and treated promptly, can lead to decreased motion and a poor outcome. Finger fractures may appear relatively minor, however, given the intricate function of the fingers these injuries require careful evaluation, early diagnosis and appropriate treatment to ensure there is no permanent disability or deformity.
Fractures and dislocations of the phalanges (fingers) occur from a variety of mechanisms. In younger patients, these injuries are more likely to be sports-related, while older patients are likely to be injured by machinery or falls.
Finger dislocations are a common injury. Dislocations occur when the bones of the finger are moved from their normal position, causing damage to the ligaments surrounding the joint.
Finger dislocations can occur in any of the joints of any finger, but most often occurs in the middle knuckle of the little, ring, middle, or index finger. Dislocation of the finger joints (including the thumb) are commonly seen in ball sports, for example football, netball, basketball and cricket when the finger is hit on the end by the ball.
Symptoms include deformity, impaired function, pain and immediate swelling followed by bruising.
Fractures of the bones of the finger are less common than joint dislocations but often also occur as a result of being hit on the end of the finger in many ball sports. Pain, swelling and deformity may be felt and the break should be iced and immobilised.
Clinical presentation of finger fractures and dislocations depends primarily on the mechanism of injury. Crushing injuries to the fingertip commonly involve the nail bed in addition to the underlying distal bone.
Injuries at the joints usually present with swelling, bruising and reduced motion. Deformity may also be present at the joint as well as in the mid-section of the bone of a displaced, unstable fracture.
Finger fractures that are non-displaced or stable are usually simply treated by immobilisation, usually splinted to another finger, however, open or unstable may required addition hospital treatment, in some cases even surgery.
Thumb injuries may require a longer period of immobilization, especially if there is clinical concern that a ligament was torn.
As with all fractures, a careful history should include the mechanism and time of injury, associated injuries, and the extent of any deformity. The physical examination should also include an assessment of swelling, neuro-vascular status, range of motion, and presence of open injury.
Swelling can be controlled using ice and immobilisation is very important, ideally and one should always seek medical advice.
Stiffness and lack of movement are common long-term symptoms if the finger is not managed effectively. In general, management of soft tissues is the first priority (after addressing any airway, breathing and circulation issues and any other more serious injuries), especially is bleeding or open wounds are present. The appropriate use of splinting is a key component of treating finger fractures and dislocations.