DEAR MAYO CLINIC: My son injured his index finger, but didn’t complain much and even played in a basketball game the next day, so we assumed it was fine. After four days, the swelling didn’t go down, and we took him to the doctor and found out it was broken. They put a cast on his entire hand — all the way up to his elbow. Why is such a huge cast necessary for a broken finger? Did we make it worse by waiting to take him in?
ANSWER: It’s unlikely that waiting a few days to see a doctor for your son’s broken finger changed the outcome of his treatment. Broken fingers are a frequent childhood injury, and, most of the time, they heal without any long-term problems. A cast up to the elbow is typical for a broken finger, because it is the most effective way to promote healing.
Children are at a higher risk for breaking bones than adults, simply because children tend to be more active. Of the bones children often fracture, broken fingers are some of the most common. Broken fingers are frequently the result of a fall onto an outstretched hand or due to a collision during a sports activity.
The most obvious symptoms of a broken finger are deformity of the finger or being unable to move it. However, as in your son’s situation, the symptoms can be more subtle, and swelling may be the main complaint. Pain, tenderness, bruising, stiffness or numbness also can signal a broken finger.
A long delay between the time of the injury and the start of treatment for a broken finger could lead to poor healing, decreased range of motion or decreased grip strength. But, waiting just a few days usually isn’t a problem.
For a bone to heal properly, it needs to be fixed in place, so it can’t move. The best way to do that is with a cast. It’s difficult to immobilize only one finger or just the hand with a cast. Casts that go up to the elbow often are used for broken fingers, because they keep the finger and hand from moving. That gives the broken bone the best chance to heal well.
For finger fractures that don’t require surgery, a cast is usually only needed for about three or four weeks. When a child is in a cast for that short period of time, it shouldn’t cause any problems with the wrist or forearm — aside from the inconvenience of dealing with a cast.
Medication to reduce pain may be helpful for your son as his finger heals. Over-the-counter pain relievers, such as acetaminophen, ibuprofen or naproxen, may be all he needs. But, if your son has severe pain, talk to his doctor. He may benefit from a prescription pain reliever, such as codeine.
After the cast is removed, your son’s doctor may recommend exercises, occupational therapy or another type of rehabilitation to ease stiffness in the finger, as well as to restore a full range of motion to the finger, hand and wrist.
There are some issues that can make healing a broken finger more complicated. They include a break that involves a finger joint, damage to ligaments around the broken bone, a break that’s the result of a crushing accident, loose bone fragments that could enter a joint, or an unstable or displaced fracture. In these situations, treatment could include surgery, and healing may take much longer.
If the facture is a simple one, it’s quite likely your son will be able to return to the basketball court and his other activities without any problems. If you have questions about your son’s treatment or the healing process, be sure to talk with his doctor. — Dr. Shelley Noland, Plastic and Hand Surgery, Mayo Clinic, Phoenix