Post-Surgery Stiffness in Proximal Phalanx Fracture: Seeking Solutions

Stiffness issues following surgery for a proximal phalanx fracture of the right little finger?

Hello Dr.
You, I was involved in a car accident on July 31 of this year, which resulted in a fracture of the proximal phalanx of my right little finger.
The doctor in Hualien recommended surgery for a quicker recovery, so I underwent internal fixation surgery with steel pins on August 12.
Initially, the doctor suggested using a self-paid plate, but after the surgery, he informed me that the fracture site had shattered when he inserted the plate, so he used a bioabsorbable bone substitute material from Noah Biotech for bone grafting along with the internal fixation pins.
The two pins were placed from the lower left side of the PIP joint to the lower right side of the MP joint.
After the surgery, the doctor advised me not to move my finger.
I expressed my concerns about stiffness, but he reassured me not to worry.
However, I have been anxious, so I have been visiting a physical therapist daily to perform more conservative movements.
On October 26, the pins were removed.
During this time, the doctor kept telling me not to worry, stating that he would manipulate my finger while I was under general anesthesia to prevent stiffness.
However, today, November 15, I am unable to extend or flex any of my finger joints independently.
Each visit to the physical therapist to bend my fingers has been extremely painful, and currently, the PIP joint of my little finger feels severely bruised and swollen.
The area from the PIP joint to the MP joint feels abnormally hard and appears much thicker than my normal little finger.
Additionally, my ring and middle fingers are also unable to flex and touch my palm for some unknown reason (I have been actively moving these two fingers during rehabilitation since the surgery on August 12).
I would like to ask the following four questions:
1.
I recently visited a new rehabilitation clinic where the doctor injected an anti-inflammatory and pain-relief injection into my PIP joint.
He mentioned that this would help me rehabilitate more comfortably.
Can this injection be administered repeatedly?
2.
During this period, I have consulted with traditional Chinese medicine doctors and several rehabilitation clinics in Hualien, but the doctors believe that recovery of the proximal phalanx is quite difficult.
If rehabilitation proves ineffective, would you recommend that I see a hand surgeon? Or should I undergo additional examinations?
3.
If I undergo adhesion surgery and engage in aggressive rehabilitation, is there a possibility of improvement? Would you recommend another surgery?
4.
Why is it that even though my little finger is fractured, the flexion range of my ring and middle fingers is also affected, and both fingers' PIP joints appear dark? Is it possible that the ligaments or other structures are injured (I have had X-rays that showed no bone issues)? What can be done for recovery?
Currently, my work is temporarily halted, and I am feeling very anxious because I do not know what to do.
I do not expect to recover to 100%, but I hope that through rehabilitation or another surgery, I can at least regain normal grip function, which is very important for my work.
I hope you can provide me with some advice! Thank you!

Ms. Zeng, 20~29 year old female. Ask Date: 2023/11/15

Dr. You Dianqi reply Orthopedics

It is advisable to discuss your concerns with your original attending physician (surgeon), as each individual's injury severity and recovery situation can vary.
Please return for a follow-up appointment to discuss your concerns with the doctor, and ask them to evaluate the subsequent rehabilitation methods or any other treatments that may be necessary.
Thank you.

Reply Date: 2023/11/15

More Info

I'm sorry to hear about your situation following your proximal phalanx fracture. It sounds like you've been through a lot, and it's understandable to feel anxious about your recovery. Let's address your concerns one by one.

1. Corticosteroid Injection: The injection you received in your PIP joint is likely a corticosteroid, which can help reduce inflammation and pain. While these injections can be beneficial, they are not typically administered frequently due to potential side effects, such as weakening of the surrounding tissues or joint structures. It's essential to discuss with your physician how often you can receive these injections based on your specific condition and response to treatment.

2. Consulting a Hand Surgeon: If your current rehabilitation efforts are not yielding the desired results, it may be wise to seek a consultation with a hand surgeon. They specialize in conditions affecting the hand and can provide a more detailed assessment of your situation. They might recommend additional imaging studies, such as an MRI, to evaluate soft tissue injuries that may not be visible on X-rays. This could include checking for ligament injuries or other soft tissue damage that could be contributing to your stiffness and pain.

3. Adhesion Release Surgery: If you are experiencing significant stiffness and limited range of motion, a surgical procedure to release adhesions (scar tissue) may be considered. This type of surgery can sometimes improve mobility, especially if combined with aggressive rehabilitation afterward. However, the decision to proceed with surgery should be made collaboratively with your healthcare team, considering the potential benefits and risks.

4. Impact on Adjacent Fingers: It's not uncommon for injuries to one finger to affect the function of adjacent fingers. This can occur due to several factors, including swelling, pain, and the interconnected nature of the tendons and ligaments in the hand. The bruising and swelling in your other fingers could indicate that they are compensating for the injured finger or that there is some underlying soft tissue injury. A thorough examination by a hand specialist can help clarify this.

In terms of rehabilitation, it's crucial to remain proactive. Here are some general recommendations:
- Physical Therapy: Continue with physical therapy, focusing on gentle range-of-motion exercises. Your therapist can tailor a program to your specific needs, gradually increasing the intensity as tolerated.

- Pain Management: Discuss pain management strategies with your healthcare provider. This may include medications, ice therapy, or other modalities to help manage discomfort during rehabilitation.

- Patience and Consistency: Recovery from hand injuries can be slow, and it's essential to be patient with yourself. Consistency in your rehabilitation exercises is key to regaining function.

- Emotional Support: Consider seeking support from friends, family, or even a mental health professional if you're feeling overwhelmed. Managing anxiety and stress can positively impact your recovery.

In conclusion, while your situation is challenging, there are pathways to improvement. Collaborate closely with your healthcare team, and don't hesitate to seek second opinions if you feel it's necessary. Your goal of regaining function in your hand is achievable, and with the right approach, you can work towards a successful recovery.

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