Finger Bone Fractures: Recovery and Rehabilitation Insights

Phalanx fracture

The fracture site is at the distal phalanx of the right fifth finger, with a rupture at the connection between the extensor tendon and the distal phalanx.
Initially, when seeking medical attention, the doctor performed surgery using two crossed steel pins to stabilize the distal phalanx and the joint between the middle and distal phalanges, as well as the connection of the extensor tendon to the distal phalanx.
I would like to ask the physician:
1.
If the surgery is successful, is it possible for the extensor tendon to be connected while there are still fragments of bone at the joint?
2.
I have reviewed all the X-rays during the treatment process.
On the day of pin removal, there were no bone fragments observed.
However, the day after the pin removal, the physician who performed the surgery demonstrated how to rehabilitate my finger at home.
While applying too much force, he faintly heard a cracking sound and I informed him that it was very painful.
That evening, my finger became severely swollen.
The next day, I sought medical attention and informed the doctor about the swelling.
The doctor replied that this was a normal part of the rehabilitation process and did not arrange for an X-ray to alleviate my concerns.

3.
Afterward, I consulted another hospital, and the X-ray taken showed a small bone fragment at the connection of the extensor tendon to the distal phalanx.
However, based on the functional assessment of finger movement, the extensor tendon appears to be connected to the distal phalanx.
Currently, there is impaired movement at the joint, and I am unable to fully extend or flex the finger, with a reduced range of motion.
However, I can push the finger straight with external assistance.
Should the presence of the bone fragment (located just beneath the extensor tendon) be causing this impairment?

Liú Làng Zǎi, 30~39 year old female. Ask Date: 2013/05/22

Dr. Tan Zhuowen reply Orthopedics

Hello, the distal tendon of the finger extensor attaches to the base of the distal phalanx.
A fracture at the base of the distal phalanx can lead to tendon detachment, resulting in an inability to extend the fingertip.
Since the tendon ends cannot be sutured, the fracture site must be stabilized, allowing for healing at the fracture site to facilitate tendon repositioning.
However, due to the small joint surface of the distal interphalangeal joint, there is a higher risk of adhesion, which often leads to complications such as joint stiffness, limited mobility, or poor healing at the fracture site post-surgery.
During finger movements, there is often a risk of re-displacement at the fracture site.

Reply Date: 2013/05/22

More Info

Understanding finger bone fractures, particularly in the context of recovery and rehabilitation, is crucial for ensuring optimal healing and regaining functionality. In your case, the fracture of the distal phalanx of the fifth finger, along with the surgical intervention involving the placement of two steel pins for stabilization, presents a unique set of challenges and considerations.

1. Surgical Success and Bone Fragmentation: If the surgery is deemed successful, it is indeed possible for the extensor tendon to heal properly while still having fragments of bone present at the joint. This situation can occur if the fracture was comminuted (involving multiple fragments) or if there was significant bone loss at the fracture site. The presence of bone fragments can lead to complications such as joint instability or limited range of motion, depending on their location and the extent of the injury.

2. Post-Operative Rehabilitation and Complications: The incident you described during rehabilitation, where you experienced a cracking sound and subsequent swelling, raises concerns. While some discomfort and swelling can be expected during the rehabilitation process, especially after a surgical procedure, the severity of the symptoms you experienced warrants further investigation. The fact that you heard a cracking sound and felt significant pain could indicate that the joint or surrounding structures were stressed beyond their current capacity. It is essential to communicate these symptoms to your healthcare provider, as they may need to assess for any potential complications, such as re-injury or additional fractures.

3. Impact of Bone Fragmentation on Functionality: The X-ray findings from the subsequent hospital visit indicating a small bone fragment beneath the extensor tendon suggest that this could indeed be contributing to your current limitations in finger movement. The presence of a bone fragment can interfere with the normal mechanics of the tendon and joint, leading to restricted motion and pain. The inability to fully extend or flex the finger, along with a reduced range of motion, can be attributed to several factors, including the presence of the bone fragment, scar tissue formation, and potential tendon adhesions.

Rehabilitation Strategies
To address these issues and facilitate recovery, consider the following rehabilitation strategies:
- Physical Therapy: Engaging in a structured physical therapy program is vital. A physical therapist can provide tailored exercises that focus on improving range of motion, strength, and functional use of the finger. They can also employ modalities such as ultrasound or electrical stimulation to promote healing and reduce pain.

- Gradual Progression: It is important to gradually increase the intensity of your rehabilitation exercises. Avoid pushing through pain, as this can lead to further injury. Instead, focus on gentle stretching and strengthening exercises that respect your current limitations.

- Pain Management: If pain persists, discuss pain management options with your healthcare provider. This may include medications, ice therapy, or other modalities to help manage inflammation and discomfort.

- Follow-Up Imaging: Given the concerns about the bone fragment and its impact on your recovery, it may be prudent to request follow-up imaging (such as an X-ray or MRI) to assess the current state of the fracture and the surrounding structures.

- Surgical Consultation: If significant limitations persist despite rehabilitation efforts, a consultation with an orthopedic surgeon may be necessary to evaluate the need for further intervention, such as removal of the bone fragment or additional surgical repair.

Conclusion
In summary, while the healing process following a finger fracture can be complex, understanding the potential complications and engaging in a comprehensive rehabilitation program can significantly enhance recovery outcomes. It is crucial to maintain open communication with your healthcare team, report any new or worsening symptoms, and adhere to the prescribed rehabilitation protocols to optimize your recovery and regain full function of your finger.

Similar Q&A

Effective Rehabilitation Strategies for Finger Fractures: A Guide

Hello Doctor, I have a teacher who fractured his little finger while playing basketball. He has undergone rehabilitation and mentioned that he made good progress in the first week, but now, three months later, there hasn't been much improvement. I'm wondering if there a...

Dr. Chen Wayda reply Rehabilitation
I don't know which hospital he is undergoing rehabilitation at. He should communicate more with his physician and therapist. Alternatively, he could visit a hospital in Taipei to better understand where the issue lies.

Post-Surgery Finger Stiffness: Recovery Tips for Fracture Patients

Hello, Doctor: I would like to ask you some questions regarding post-fracture recovery and would appreciate your advice. Thank you for your help. I suffered a fracture of the second phalanx of my right index finger due to a car accident, and it has been almost a month and a half ...

Dr. Shi Guozheng reply Orthopedics
Finger fractures can lead to poor joint mobility, and rehabilitation must begin within six weeks; otherwise, it may result in an inability to bend the finger. The approach is to teach you how to perform rehabilitation exercises and to encourage you to do them as much as possible.

Rehabilitation Strategies for Boxer's Fracture and Ligament Tear

Hello doctor, I had a car accident on September 13th, resulting in a comminuted fracture of my left hand's ring finger and a ligament tear. I had the metal pins removed on October 4th. What rehabilitation exercises should I do to recover to 100%? The hospital doctor advised ...

Dr. Chen Xianchang reply Rehabilitation
1. If your fingers are too swollen, you can perform a contrast bath method as follows: Soak in warm water (about 104°F) for five minutes. Then soak in cold water (50-60°F) for one minute. Repeat this alternating process five times for a total of 30 minutes, doing it once in the m...

Challenges and Solutions for Nonunion Fractures in Hand Surgery

Hello Doctor: Last October, my finger was crushed by a metal plate. Except for my thumb, the other fingers suffered from bone fractures, as well as vascular and nerve damage. After the first surgery, my middle finger still had poor blood flow, so I underwent another operation whe...

Dr. Zhou Hongzhang reply Plastic Surgery
1. This condition may require a complete medical history or a consultation with the original treating physician for a better prognosis. 2. Poor fracture healing can have many causes, such as severe injury, compromised circulation, wound infection, and so on. 3. Hyperbaric oxy...