Broken digit

Published March 14, 2021, 12:58 AM

by Dr. Jose Pujalte Jr.


Dr. Jose Pujalte, Jr.

“The least pain in our little finger gives us more concern and uneasiness than the destruction of millions of our fellow beings.” – William Hazlitt (1778 – 1830) English writer, Edinburgh Review, Oct 1829

The trouble with hand injuries – fractures in particular – is that they’re taken for granted. “That’s nothing!” yells your friend after a palpable “Craaaackkk” of your digit in a finger-wrestling bout. “That’s nothing!” after a sloppy punch that leaves his 5th finger visibly shortened.   With such nonchalance, the broken hand becomes a pitiful hand.

How Hand Fractures Occur. There are two ways of breaking the bones of the hand: one, by a direct blow on it, for example, from a baseball bat; two, when the hand strikes a hard(er) surface such as a cement floor (from a fall) or the car dashboard (in a vehicular accident). Obviously, the hand bones can also be pulverized by gunshot. It must be added that the condition of the bone — if it is brittle from osteoporosis — means that the fracture will be suffered more readily.

Signs & Symptoms.  A high index of suspicion is helpful because a fracture can be mistaken for a severe sprain or dislocation. All three (fracture, sprain, and dislocation) share common observations. These are: swelling, tenderness, deformity, inability to move finger and numbness (with or without).

First Aid. Before going to the emergency room or clinic, it makes sense to prevent further injury by protecting the suspected fracture by splinting. Injured knuckle bones (metacarpals) can be immobilized by placing a sturdy piece of plywood or hard cardboard under the palm extending to as far as the elbow. Secure it with an elastic bandage or a clean piece of cloth. Broken finger bones (phalanges) can be “buddy-taped” to the adjacent unaffected finger. For example, a popsicle stick or tongue depressor can be wedged between a fractured fourth digit and the normal third. The two fingers can then taped together.

Diagnosis. How the fracture will be treated by the emergency physician or orthopedic surgeon depends on what break appears on xray.  This so-called “fracture pattern” can be a simple break, spiral, or comminuted (shattered). Sometimes, the fracture is associated with a dislocation or separation of the joint. A gunshot wound on the hand makes it a compound or “open fracture”. In this case, infection is likely and the treatment must include surgery to clean out the wound and bone. Don’t be surprised if the doctor will suggest an emergency operation.

Treatment. Conservative care may involve closed reduction or bone-setting followed by immobilization with a splint or cast. If the bone fragments are oriented in a way that the reduction will be lost by simple casting, the doctor may recommend surgery. This then is open reduction followed by fixing the fragments in place with metal implants such as pins, wires, screws and bone plates.

The hand is a precise and superbly engineered instrument.  Any attempt to ignore injury results in poor function, chronic pain, or both.  Now if the reaction to a stiff, emaciated hand is still “That’s nothing!” that indeed would be a pitiful man.

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NOTE FROM THE AUTHOR: This is my last column in the Editorial & Opinion Pages. I will move to the Health Section after March 15, 2021.