Surgery on a Broken or Fractured Finger: When Is a Broken Finger Surgery Needed?

Finger fractures are incredibly common. Some can be treated conservatively with bracing, casting, and even buddy taping. However some fractures require surgery for the best chance at healing and function.

Some broken or fractured fingers are worse than others, so you may need a broken finger surgery. Here are some indicators that this may be the case.

How to know if surgery is needed?

The simplest answer is x-ray. Some finger fractures cause an obvious deformity - crooked or bent finger- and they almost always need surgery. However, a finger may seem straight but actually needs surgery. The x-rays show not only the shape and position of the bones but the shape and position of the joints. Even small disruptions of the joint surface may require surgical intervention. This is not a decision you could/should make alone. Seek consultation with a hand surgeon.

How serious is a broken or fractured finger?

Depending on the location and the severity of the injury, a broken or fractured finger can be incredibly problematic. A fracture after which you fail to visit a broken finger specialist (or a broken finger surgeon) can be quite problematic. Remember that we’re not talking about hairline cracks but rather fractures which result in poor functional outcomes. In these scenarios, you may suffer from the following:

• Malunion: This happens when bones heal but are not aligned correctly. Even though the bone has healed, the position is incorrect. This will drastically affect your finger's functionality in the long run. This may limit the range of motion of the joint or potentially cause one finger to rotate under the other - a term called “scissoring”.
• Arthritis: This occurs when the joint surface is damaged and no longer smooth. Certain finger fractures, especially “jammed fingers” involve a crushing or splitting injury in the joint surface. If not treated with surgery, the joint surface will remain uneven which results in arthritis and limited finger range of motion.

Undergoing a broken finger surgery to avoid these outcomes is a smart idea.

What types of finger fractures are there?

Generally speaking, there are several types of finger fractures.

• Closed fracture - this is the most common type.
• Open fracture - this is when the bone breaks through the skin or the skin tears over the location of fracture.
• Oblique fracture - occurs with diagonal loading (falling and hitting your hand)
• Spiral fracture - is due to a rotational force (finger caught in a drill)
• Transverse fracture - usually happens with a crush injury (dumbbell falls on your finger)
• Comminuted - multiple fragments, this can happen with any type of fracture
• Avulsion fracture - where a tendon or a ligament pulls a piece of bone off examples include bony mallet fracture. 
• Buckle fracture - occurs only in children. The bone does no break but actually bends.

These fractures can occur in the bones of the fingers (phalanges) as well as the bones o fthe hand (metacarpals).

Phalanges are the individual bones in fingers, while metacarpals are long bones that connect each finger with the wrist. For each finger, you have three phalanges and one metacarpal bone. The thumb only has 2 phalanges - it is also not a finger, it is a thumb! 

Both metacarpals and phalanges can fracture from similar forces.

Your treatment will depend on the severity and the type of the fracture.

What can be done for a broken finger before the surgery?

Right off the bat, you need to start by seeking medical attention from a trained professional. While everything to know about broken fingers can be summed up rather quickly, you still lack the expertise and experience to conduct an accurate self-diagnosis. You also lack the knowledge and insight to propose a future course of action.

The immediate thing that you should do is immobilize the finger, apply ice, and elevate the hand. If you’re in severe pain (likely to happen), you’ll probably do well to take over-the-counter pain medication. Also, if you’re going to the ER, it’s smart to take someone else to drive you there. And don’t eat or drink anything before you go because if you need surgery you need to have an empty stomach.

What does a broken finger surgery usually look like?

There are two things to consider. The first is - how are we going to keep you pain free? The second is - how is the hand surgeon going to fix the broken bone(s)? 

Anesthesia

Anesthesia is pretty straightforward. It can be local only (just injection numbing medication into the finger that is fractured, it’s like going to the dentist), sedation (you are dazed and comfortable), or general (you are asleep). 

Surgery

The finger fracture surgery is more tricky. Some fingers can be treated without an incision, other fractures necessitate that the finger needs to be opened to allow the bones to be better aligned. If the bone can be aligned without opening that is good news for you. 

Unfortunately, this sometimes cannot be determined until the operation when the surgeon is manipulating the finger. The surgeon can fix the bones several ways. The most common is with very thin nails, called k-wires. These are drilled into the bone through the skin, so they stick out of the skin and are pulled out of the bone several weeks after surgery, once the bone is healed. These are temporary and the removal is usually done in the office. This tends to be the most common way to treat broken fingers. 

Other options include plates and screws which are the least common as they cause the most stiffness. Recently, hand surgeons are using screws that go down the shaft of the bone, called the intramedullary canal. They have the benefits of being very strong and also allow the finger to move right after surgery. Therapy can happen immediately, whereas with k-wires this sometimes is not the case as the wires prevent the motion. Lastly, arthroscopic treatments are not usually used.

After the dressings are placed, your hand is usually then placed into a splint (aka “soft broken finger cast”) until you see the doctor in the office. Depending on the fracture and surgery you may be sent to a hand therapist to work on range of motion and strength. Some patients may also get a orthosis (custom splint) made for them by the hand therapist. 

Post-surgery

After the surgery, you’ll receive instructions and have to report for regular check-ups with follow up x-rays to ensure that the fracture is healing well. If you have k-wires they are usually pulled in the office - this is usually quick without much pain.

Remember that the procedure may vary between different people and fracture types.

How long does a broken finger surgery take? 

The simplest surgeries (and when everything runs smoothly) can take less than 30 minutes. However, standard surgeries will take anywhere between 30 minutes and several hours. The good thing is that, in most scenarios, you won’t have to undergo an overnight stay. You will be released home right away.

What is the fractured finger recovery time?

Generally speaking, like any other break, if the injury/fracture is not too serious, it may heal within a few weeks. The key thing is that just because the bone has healed, this doesn’t mean that the full functionality has returned to your finger. Full recovery, on the other hand, may take several months as patients can have stiffness which limits the finger motion

Now, recovery from a fractured finger surgery can take a while longer. However, it’s very important that you don’t mix up the cause and the result here. You see, the fracture that made the surgery necessary had to be more serious than just a standard fracture. Therefore, even if it could have healed without surgery, it would take longer. You should probably talk to your surgeon in the aftermath for a more accurate estimate.

The key thing to remember is that postponing surgery takes you nowhere. Speaking of which…

When is it too late to fix a broken finger?

Broken fingers will almost always heal on their own, but the position may not be optiimal for correct function. 

While it’s impossible to give you an exact date or a timeline on which seeking help will be late, there is a time past when you’ll miss the window of opportunity to get the best possible outcome. Finger fractures tend to heal quickly because of the good blood supply to the fingers and hand as well as the type of fracture and bone. Many fractures have a lot of surface area so the bony contact is a lot. 

So, when you are injured, go to a medical professional and check if your finger is broken as soon as possible. If it is, you need to start treating it right away.

Wrap up

If you’ve never had a broken finger, you have no idea how serious quality-of-life detriment is for this. Remember that this is a temporary inconvenience if you treat it correctly. If not, this problem may persist and cause many problems. So, never postpone seeking treatment for your fractured finger. Consider fractured finger surgery seriously if your doctor suggests it.