One minute, your kids are clambering into the car or having a blast playing basketball. The next minute, someone has a stubbed or smashed finger. These types of injuries are some of the most common fractures I see as a pediatric hand surgeon.
Finger fractures are very common, disruptive injuries in children. These fractures come in all shapes and sizes, with some injuries more serious than others. Finger fractures require immobilization (such as splints or casts), which can make it hard to write, brush teeth, comb hair, take a shower or bath, and even get dressed!
The most common types of finger fractures include:
- Crush/Tuft fractures - These injuries happen when the finger breaks due to being crushed or hit hard near the fingertip. Most commonly they occur due to a finger getting slammed in a door.These fractures can affect the fingernail, bone and tissue, causing pain, deformity, blood under the nail, swelling, bruising and even bone sticking out through the skin. These fractures usually require a splint or cast, but generally heal very well.One of the concerns is nail deformity.
- Seymour fractures – These are very serious injuries which requires a procedure to be performed in the emergency department or in the operating room.These are growth plate injuries which are open and thus are at risk for infection.Patients need to take a course of antibiotics.The two concerns with these injuries are growth arrest (the bone stops growing) and deep infection.
- Phalangeal neck fractures – This injury usually happens when a finger takes a direct hit, often during sports. It causes pain, swelling and loss of motion in the finger. It usually requires surgery, which involves placing pins and a cast, to heal correctly.
- Mallet finger fractures – These injuries often occur in baseball, volleyball, and basketball, or any activity when the fingertip takes a direct hit. The hit bends the fingertip so far that it causes the tip of the finger to sag or droop (what we call as an ‘extensor lag’). It also causes swelling, pain and bruising. Most of these injuries only require a simple splint, but the splint must be worn around-the-clock for 4-6 weeks.
- Volar plate fractures – This type of injury affects the middle joint in the finger when it is over-extended, “jammed” or “sprained.” It can injure the ligament and disconnect a small piece of bone in the joint, causing swelling, pain, bruising and loss of motion. With a few days of splinting and then buddy taping to mobilize the finger, these injuries usually heal quite well.Long term, the joint might be a little more ‘bulky’ than others.
What to Do if Your Child has an Injured Finger
If your child has an injured, swollen finger, don’t try to treat it at home; get it X-rayed. Children begin to heal very quickly. If you wait a week and it was a fracture instead of a sprain, your child may have already begun to heal in a way that could cause long-term pain, arthritis, or deformity in the finger.
When in doubt, get the finger checked! Once you know for sure, you can follow the right tips for pain management, finger care and follow-up.
Care Tips for a Fractured Finger
Unlike when you have a broken arm or leg, having a broken hand affects almost everything we do. From eating cereal in the morning to putting on pajamas at night, your child will have to learn a new way of doing things while the broken finger is taped, splinted, pinned, or in a cast.
Here are a few tips for care while treating your child’s broken finger:
- Get creative with hygiene. You can buy a cast cover online, but a homemade plastic bag and duct tape do the trick just as well. Cover the hand during showers and use an electric toothbrush to make it easier to brush with the non-dominant hand if the other is injured. If your child is old enough and doesn’t want assistance washing hair, they can get a low-cost shampoo at a salon.
- Expect your child to need lots of help. Whether or not they ask for it, your child will likely need assistance carrying things, taking care of personal hygiene, doing homework and taking part in other activities that they previously did unaided. Offer help repeatedly until your child gets into a new routine for self-care.
- Cut corners. Wear pants with elastic waistbands rather than buttons and zippers and avoid shirts with snug cuffs. Opt for slip-on shoes or sandals. Consider headbands instead of ponytails and other simple substitutions to make dressing easier. If your child packs a lunch, avoid prepackaged foods that require dexterity to open, such as twist caps, foil packaging lids, etc.
- Talk to your child’s school. Schools are required to offer accommodations for kids with injuries. Bring a note from the doctor explaining the injury, what type of assistance may be required and for how long. Depending on the school district, your child may be partnered with a care assistant during the school day, receive more time for exams, or receive alternative homework assignments that don’t require handwriting or typing.
- Follow the doctor’s instructions. Your child will likely need to avoid rigorous activities for at least 1 month after the injury – in some cases 2 months or more. He or she may also be told not to lift, jump, or do other strenuous activities until the finger is well healed. You may be given advice for icing the finger to reduce swelling. The doctor may also prescribe medications to prevent infection, reduce swelling and ease pain. Follow up with the doctor according to your child’s care plan to make sure their finger heals properly.
Click here to learn more about the Hand and Upper Extremity Program at Nationwide Children’s Hospital.