Finger Fractures (Broken Finger)

What a Finger Fracture Is

Each finger has three bones, the phalanges; the thumb has two. They connect to five longer bones in the palm, the metacarpals, which meet the finger bones at the knuckles. A fracture can occur in the middle of any of these bones or at its end, near a joint, and it can run straight across the bone, spiral around it, or break it into several pieces.

The most common hand fracture is the boxer’s fracture, a break in the neck of the fifth metacarpal just below the knuckle of the pinky finger. It usually happens when a closed fist strikes something hard, though a fall can cause it too, and it is what most people mean when they describe a broken knuckle or a broken pinky knuckle. The knuckle may look sunken where the end of the bone has been pushed out of place.

Some fractures pull away only a small chip of bone where a ligament or tendon attaches. These avulsion fractures are still broken fingers, and the attached ligament or tendon often matters as much as the bone.

Symptoms of a Broken Finger

According to AAOS, the signs of a finger or hand fracture include:

• Swelling, bruising, and tenderness over the injured bone
• A finger that looks bent, crooked, or shorter than it should
• Being unable to move the finger fully
• “Scissoring,” where the injured finger crosses over its neighbor when you make a fist

A broken finger and a badly sprained one can look much alike in the first hours. If you are trying to decide whether a sore finger is jammed or broken, an X-ray is the only way to see the bone.

A cut over the injured area, bone visible through the skin, or a finger that is numb, pale or cold needs prompt care, because these can mean an open fracture or an injury to a nerve or blood vessel.

How a Hand Specialist Diagnoses a Finger Fracture

The evaluation starts with how and when the injury happened. A hand surgeon then checks the finger’s alignment with the hand held flat and again in a fist: when the hand closes, the fingers should not overlap, and the fingernails should all point toward the base of the thumb. A finger that rotates out of line is a sign the fracture may need more than a splint.

The exam also checks the tendons, nerves, and ligaments, which are often injured at the same time as the bone. A fingertip that droops and will not straighten, for example, can mean the tendon that straightens it has torn or pulled off a fragment of bone (a mallet finger), which is treated differently from a fracture alone.

X-rays, available through the practice’s orthopedic imaging services, show which bone is broken and the fracture pattern. A CT scan is sometimes used to better understand the fracture.

Treatment for a Broken Finger

Treatment depends on which bone is broken, where, whether the pieces have shifted, and whether the fracture is stable. Your hand surgeon will recommend the least-invasive option likely to let the finger heal in the right position.

Nonsurgical treatment

Many finger fractures heal without surgery:

• Closed reduction: if the bone has shifted, it can often be moved back into place without an incision.
• Splint or cast: the finger is held in position while the bone heals, sometimes with the neighboring finger included for support. Depending on the fracture’s location and stability, AAOS describes splinting for about three weeks and casting for three to six weeks.
• Buddy taping: for some stable fractures that have not shifted, taping the injured finger to its neighbor protects it while still allowing early movement.
• Follow-up X-rays: typically taken within a week or two to confirm the bone is staying in position while it heals.

Surgical treatment

Surgery may be recommended when a fracture cannot be held in good position with a splint or cast. That includes fractures that have shifted and are unstable, fractures that have rotated, open fractures where the bone has broken through the skin, and many fractures that extend into a joint. AAOS notes that joint fractures that are not treated promptly and adequately can lead to lasting finger dysfunction and arthritis.

Hand surgeons fix finger fractures with pins, wires, screws or small plates. Some fractures can be pinned through small punctures in the skin rather than an open incision. Depending on how strong the repair is, the finger may be allowed to move soon after surgery to limit stiffness. Some hardware stays in place permanently and some is removed after the bone heals. Breaks in the larger bones of the forearm near the wrist are covered separately under distal radius fracture treatment.

Finger Dislocations and Volar Plate Injuries

A dislocation happens when the bones of a finger joint are pushed out of their normal position, most often at the middle knuckle. A dislocated finger that has been put back in place can still have torn ligaments or a fracture at the joint surface, so it is worth an X-ray even when it looks normal again.

The volar plate is a thick band of tissue on the palm side of the middle knuckle that stops the finger from bending backward. When a ball strikes an outstretched finger or a fall forces the finger back, the volar plate can tear, sometimes pulling a small chip of bone with it. Most volar plate injuries are stable and are treated with a short period of protection, often buddy taping, followed by early movement, because a finger joint held still for too long stiffens. An injury that leaves the joint unstable, or that breaks off a larger piece of the joint surface, may need surgery. Swelling around the knuckle often lasts for weeks.

Recovery, Stiffness and Hand Therapy

Finger joints stiffen when they are held still, and stiffness is a common problem after a finger fracture. Once your surgeon approves movement, gentle exercises help restore motion and reduce swelling. AAOS notes that these can usually begin after about three weeks for many hand fractures.

Hand therapy is often an important part of regaining motion after a finger fracture. Midwest Orthopaedics at Rush’s occupational therapists work with the hand surgeons to make custom splints, guide range-of-motion and strengthening exercises, and manage swelling. Hand therapy is available at most of the practice’s locations.

Most finger fractures heal with good function when they are treated promptly and appropriately. When a finger stays stiff after the bone has healed, a later procedure to release scarred tendons or tight joint tissue, or to remove hardware, is occasionally considered.

Finger Fractures in Children

Children’s bones grow from growth plates, areas of cartilage near the ends of the bones, and AAOS notes that the long bones of the fingers are the most common site of growth plate fractures. Because the growth plate helps determine the final length and shape of the bone, these injuries usually need prompt attention and follow-up to confirm the finger is growing normally. MOR’s pediatric orthopedics team treats growth plate fractures in children and adolescents alongside the hand surgeons.

Finger Fractures at Work

Hand and finger fractures can happen at work: a finger crushed in machinery or caught in a door, a power tool accident, or a fall onto an outstretched hand. When a broken finger is work-related, the same hand team handles evaluation, treatment and return-to-work planning through MOR’s workers’ compensation program.

For more complex injuries involving several broken bones or severe soft-tissue damage, the hand surgeons work alongside MOR’s fracture care specialists.

Meet the Hand Team

Every hand and wrist physician at Midwest Orthopaedics at Rush has completed a dedicated hand surgery fellowship after orthopedic residency. The hand team treats finger fractures, tendon injuries and dislocations from splinting through surgical repair, working alongside the practice’s occupational therapists through recovery.

Frequently Asked Questions

How long does a broken finger take to heal?

It depends on the bone and the fracture. AAOS describes splinting for about three weeks for many finger fractures, and casting for three to six weeks for some hand fractures, depending on where the break is and how stable it is. Regaining full motion and strength often takes longer than the bone itself, which is why hand therapy is part of recovery for many patients.

Does a broken finger need surgery?

Many do not. Finger fractures often heal in a splint, a cast or with buddy taping. Surgery is generally considered when the bone has shifted and cannot be held in place, when the finger has rotated out of line, when the bone has broken through the skin, or when the fracture extends into a joint.

Is a broken knuckle the same as a broken finger?

Often it is a break in the hand bone just below the knuckle rather than in the finger itself. The most common example is a boxer’s fracture of the bone below the pinky knuckle. It is evaluated and treated by the same hand surgeons.

Can I buddy tape a broken finger?

Buddy taping suits some stable fractures that have not shifted, but not all of them. Taping a finger that has rotated, or one with a tendon injury that needs a joint held straight, can let it heal in the wrong position. A hand surgeon can tell from the exam and X-ray which support the injury needs.

Do I need a referral to see a hand surgeon?

No referral is needed to schedule with Midwest Orthopaedics at Rush. Check with your insurance plan if a referral affects your coverage.

Requesting an Appointment

You can request an appointment online, or view the full list of MOR office locations to find the one most convenient for you.

This page describes services offered by Midwest Orthopaedics at Rush and is not medical advice. Finger injuries have several possible causes, and only an in-person evaluation and X-ray can determine which one applies to you. Please consult a physician about your own injury.