Crush Fractures of the Ring Finger: Recovery and Concerns

Crush fracture of the ring finger?

Hello Doctor: I have a comminuted fracture in the second phalanx of my ring finger.
The attending physician said that the upper half of the joint is fine, but the lower half is broken into three pieces.
They performed surgery and inserted two steel pins (after surgery, my ring finger was stabilized with a wooden splint).
However, during a follow-up appointment one month later, an X-ray revealed that the phalanx had become dislocated again (without any trauma).
They performed another surgery and inserted four steel pins (using a cast to stabilize my hand from the last three fingers to the forearm in a U-shape).

Q1: I also have a fracture in my fifth metacarpal.
The X-ray shows it is just separated without dislocation, so the doctor said it doesn't need to be stabilized, and there has been no follow-up.
Will not stabilizing it cause it to misalign?
Q2: After the first stabilization, why did it dislocate without any impact? The doctor mentioned it could be due to the nurse being too rough while changing the dressing.
Is it common for the steel pins to become loose so easily?
Q3: It has been a week since the surgery, and my finger is still very numb.
Is this normal?
Q4: Although my finger is currently in a cast, it can still move inside.
With four steel pins in place, will it become misaligned again? Additionally, the nurse advised me to move my fingers frequently.
Will this affect the healing of the bone or the stability of the pins? Thank you, Doctor.

yo, 20~29 year old female. Ask Date: 2013/12/21

Dr. Chen Xingyuan reply Orthopedics

Dear Reader,
Using steel pins for the fixation of finger fractures is a common and widely accepted surgical method.
Its advantages include less tissue disruption and easier removal of the pins.
However, its fixation strength is relatively weak, and appropriate protection is necessary post-surgery to prevent re-displacement of the fracture or loosening of the pins.
Any fixation method is relative; if the external force is strong enough, there is a possibility of re-displacement or pin loosening.
In cases of fractures without displacement, splint protection is still advisable for safety.
Proper fixation can help prevent further displacement, reduce pain, and promote better healing of the bone.
Additionally, the degree of comminution of the fracture can affect the fixation strength of the pins and the healing capacity of the bone.
Numbness in the hand is a neurological issue and may be associated with injuries that occurred during the fracture.
If there is gradual improvement, it is likely not a concern.
While excessive protection and restriction of joint movement can help reduce the chances of re-displacement or pin loosening, it may also impact the recovery of hand function.
Therefore, it is essential to find a balance, and it is best to follow your attending physician's advice and cooperate with rehabilitation therapy to minimize functional loss.
Wishing you a speedy recovery!
Sincerely,
Dr.
Chen

Reply Date: 2013/12/21

More Info

Crush fractures, particularly of the ring finger, can be quite complex and concerning, especially when surgical intervention is involved. Based on your description, it seems that you have undergone multiple surgeries and are currently dealing with a variety of issues related to your recovery. Let’s address your questions one by one, while also providing some context about crush fractures and their implications for recovery.

Q1: Will not fixing the fifth metacarpal lead to misalignment?
In general, if a fracture is stable and there is no significant displacement, it may not require fixation. However, the risk of misalignment or malunion increases if the fracture is not properly monitored. It’s crucial to follow up with your healthcare provider to ensure that the fracture is healing correctly. Regular X-rays can help assess the healing process and determine if any intervention is necessary.

Q2: Why did the fracture displace after the first fixation?
Fractures can displace for several reasons, even without direct trauma. Factors such as inadequate stabilization, excessive movement during the healing process, or even the mechanical stress from daily activities can contribute to this issue. If the fixation was not secure or if there was significant swelling or muscle tension, it could have led to the displacement. It’s also possible that the nurse's handling during dressing changes could have inadvertently stressed the area, leading to loosening of the hardware.

Q3: Is it normal for the finger to feel numb after surgery?
Numbness after surgery can be a common occurrence, especially if there was any nerve involvement during the procedure or if swelling is pressing on nearby nerves. However, persistent numbness should be monitored closely. If it does not improve or if you experience increased pain, it’s essential to consult your physician, as this could indicate complications such as nerve damage or inadequate blood flow.

Q4: Will movement within the cast affect healing?
While it’s important to keep the finger immobilized to allow for proper healing, some gentle movement may be encouraged to maintain circulation and prevent stiffness, but this should be done under the guidance of your healthcare provider. Excessive movement or pressure can indeed affect the healing of the bone and the stability of the hardware. It’s crucial to follow the specific instructions given by your surgeon regarding movement and rehabilitation exercises.

Additional Considerations
Crush fractures can lead to complications such as stiffness, chronic pain, and reduced range of motion, particularly in the fingers. The recovery process can be lengthy, often requiring physical therapy to regain strength and function. Here are some general recommendations for managing your recovery:
1. Follow-Up Appointments: Attend all scheduled follow-ups with your orthopedic surgeon to monitor the healing process through X-rays and physical examinations.

2. Physical Therapy: Once cleared by your doctor, engaging in physical therapy can be beneficial. A therapist can provide exercises tailored to your specific needs, focusing on regaining range of motion and strength.

3. Pain Management: If you experience significant pain or discomfort, discuss pain management options with your healthcare provider. This may include medications or alternative therapies.

4. Monitor Symptoms: Keep an eye on any changes in sensation, swelling, or pain levels. Report any concerning symptoms to your doctor promptly.

5. Rest and Elevation: Ensure that you rest the affected hand and keep it elevated to reduce swelling.

In conclusion, while crush fractures can be challenging, with appropriate medical care and rehabilitation, many individuals can achieve a good recovery. It’s essential to maintain open communication with your healthcare team and adhere to their recommendations for the best outcomes.

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