Broken finger or thumb
A finger seems like a small thing, which is why finger injuries are the ones people most often put up with: caught in a door, struck by a ball, banged against…
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Medicines commonly prescribed for Broken finger or thumb
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 650 mgActive substance: paracetamolManufacturer: Haleon Spain S.A.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 200 mgActive substance: ibuprofenManufacturer: Farmalider S.A.Prescription not requiredDosage form: ORAL SOLUTION/SUSPENSION, 400 mgActive substance: ibuprofenManufacturer: Zambon S.A.U.Prescription required
A finger seems like a small thing, which is why finger injuries are the ones people most often put up with: caught in a door, struck by a ball, banged against a door frame, snagged in a fall. Yet almost all the fine work of the hands rests on those bones, and carelessness here costs more than it does with a large bone. A finger that heals crooked is a daily nuisance: it will not go into a glove, it catches in a pocket, it loses grip strength. Hand fractures heal well, but only if they are spotted in time and set properly, and by eye a fracture cannot be told from a dislocation or a bad bruise.
How to tell whether a finger is broken
Nothing short of an X-ray settles it, but the pattern of signs speaks for itself:
- the finger swells and darkens quickly, the skin goes tight and a ring will no longer come off;
- the pain is sharp and pinpoint, and worsens on bending or on pressing along the length of the finger;
- the finger sits crooked, angled off to one side, or will not fully straighten;
- a dark patch of blood builds up under the nail;
- gripping anything in a fist or holding a mug becomes impossible.
There is a simple check for rotation of the fragments. Slowly and gently curl all the fingers as though holding a ball, then look at the hand from the side. Normally all the fingertips point towards one spot at the base of the thumb. If one finger rides over its neighbour and crosses it, the fragments have twisted around the axis of the bone. That kind of displacement never corrects itself and almost always needs a doctor's hands on it, even when the fracture looks modest on the X-ray.
When you need urgent care
Go to an emergency department or an on-call trauma service without waiting until morning if:
- the finger has turned pale, blue or numb, and feels cold;
- the finger sits at an unnatural angle or is clearly shorter than the others;
- bone is visible in a wound, or the wound lies directly over the fracture;
- a ring has dug into the swollen finger and will not come off;
- bleeding does not stop with pressure;
- the wound over a knuckle came from striking someone's face or teeth.
The last point sounds odd, but this is one of the most treacherous hand injuries there is. A tooth mark over the joint looks like a scratch and is in fact a puncture of the joint with a dirty object. Within a day or two a severe infection develops there, and by then it takes surgery and intravenous antibiotics. A wound like that is shown to a doctor the same day, however trivial it looks. For the same reason any bite to the hand should not wait.
Three injuries that are missed most often
A displaced fracture shows on the X-ray, but these injuries are regularly written off as a sprain, and the window in which they are still easy to put right closes.
- Mallet finger. After a blow to the tip of a straight finger — a ball, the corner of a duvet while making the bed — the tendon tears off the last bone, often with a flake of bone attached. The fingertip droops and will not straighten by itself, although it still bends. The treatment is a splint holding the tip perfectly straight for six to eight weeks without a single break: take the splint off to wash your hand, let the finger bend, and the clock starts again. A missed mallet finger leaves the tip permanently bent and deforms the whole finger.
- Skier's thumb. Falling with a pole in the hand, or having the thumb wrenched sideways, tears the side ligament at its base. Swelling is slight, there is no fracture, and people live with it for months. The result is a weak pinch: a key, a pen or a sheet of paper slips out. Sometimes the torn ligament end folds over in a way that makes healing impossible, and surgery is needed. So pain at the base of the thumb after an injury, particularly with a feeling of looseness, is a reason to be examined rather than to wait.
- Nail bed injury. Blood under the nail builds pressure and hurts a great deal, and it often hides a torn nail bed and a fracture of the last bone. A doctor releases the blood through the nail and the pain stops almost at once. Do not make a hole in the nail yourself: introducing infection is easier than it looks. If the nail bed is torn and left unrepaired, the new nail grows crooked or split.
The first few hours: what you can do yourself
- take every ring off that hand straight away; an hour later it will be impossible;
- tape or bandage the injured finger to the healthy one beside it with a little soft fabric in between; the thumb is not strapped this way;
- keep the hand above the level of the heart and rest it on a pillow at night: nothing else reduces swelling as effectively;
- apply something cold through a cloth for 15–20 minutes every two or three hours;
- rinse any wound under running water and cover it with a clean dressing;
- paracetamol is a reasonable painkiller; ask a doctor about anti-inflammatory ones.
Do not pull on the finger or try to straighten it, do not work it "through the pain", and do not wrap a swollen finger tightly all the way round, because the dressing will cut off the blood supply. If surgery is a possibility, it is better not to eat or drink before you are seen.
What the doctor will do
They start with X-rays of the hand in two or three views, which show the fracture line, the displacement and whether the break runs into a joint. The neighbouring fingers are examined too, since a blow rarely damages just one.
If the fragments have shifted, the finger is numbed with an injection at its base and the bone is put back into place by hand. It is then held: with a splint, with a plaster slab across the hand, or simply strapped to the finger next door, which has the advantage of letting the finger keep moving instead of stiffening.
Surgery is needed for fractures running into a joint, for rotated fragments, for fractures in several pieces and open fractures, and whenever the bone will not stay where it is put. The fragments are held with fine wires or with tiny screws. An open wound is cleaned, antibiotics are given where necessary, and the date of the last tetanus vaccination is checked.
A repeat X-ray is usually taken after one or two weeks: the small bones of the hand slip easily under a dressing during the first few days.
Healing and getting movement back
Bone in a finger unites in roughly six to eight weeks, though the splint usually comes off earlier, at three or four. Grip strength is the last thing to return, taking three to four months and sometimes longer.
The main enemy here is not the fracture but immobility. Finger joints lose their range within days and take months to win it back, so the modern approach is to immobilise exactly as much as necessary and to start moving as early as possible. Do not keep the strapping on longer than you were told "just to be safe": a stiff finger is a bigger handicap than one that does not quite straighten. Everything outside the dressing — the other fingers, the hand, the wrist — should be moving from day one.
Swelling lasts longer than people expect: some puffiness and a thickened joint can persist for six months, and the finger stays sensitive to cold for a long time. It is irritating, but normal.
It is worth being seen again if pain and swelling are not settling after a few days, if the finger will not straighten once the dressing is off or is clearly angled to one side, if it crosses its neighbour when you make a fist, or if redness is spreading around a wound, there is throbbing pressure, discharge of pus, or a fever.
Online consultation
An online appointment helps answer the main question of those first hours: go for an X-ray now, or safely wait until morning. From a description of the injury and a photograph of the finger, the doctor can judge how likely a fracture is, whether there are signs of rotation or of a torn tendon, and explain how to strap the finger until it can be examined. If the X-ray is already done, they can go through the report and advise when the dressing can come off and how to restore movement. It is also worth getting in touch later, if the finger will not straighten, has lost strength or is getting in the way of your work: the sooner a doctor looks at it, the better the chance of avoiding an operation.
This material is for information only and does not replace medical advice.
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