Broken locked thumb and differing doctor opinions

Hello everyone,

Ok the story goes like this: About a month ago (October 18, 2011) I had a motorbike accident. I was OK but after I took off my gloves I noticed my left thumb looked a bit weird. I went to A&E where I had x-rays and was told I had an avulsion fracture at the base of the thumb and a break at the top of the thumb (on the distal phalange) and they put an Elastoplast splinter.

1 week later I had to visit the UCLH fracture clinic where an orthopaedic told me it should heal with conservative treatment and they changed the Elastoplast splinter with a plastic one.

3 weeks later (total 4wks) I went back and had a new set of x-rays. This time a different orthopaedic came over, he took the splinter off, and very simply told me that because the bone has gone in the joint I will not be able to move the tip of my thumb anymore but a few degrees..

This obviously shocked me, especially after all the reassurance I was given before, and since I am in general quite active (do drums, boxing). So, I immediately visited a private orthopaedic for a second opinion who had another set of x-rays done:

Left thumb bottom aspect
http://tinypic.com/r/2mnq1af/5

Left thumb side aspect (as you look the hand from the top)
http://tinypic.com/r/10mihyd/5

He had a different opinion. He thinks that there is enough room in the joint for movement and that I will probably be able to bend it again but sent me for an MRI scan as well, which I am having next week.

My thumb at the moment feels locked on that position and is still bruised at the joint but with a bit of slow repetitive movement exercise I managed to get a few extra degrees of movement than when I got the splinter off (tendons seem to be OK). So, my questions are:

1) Do you think that I will be able to bend my thumb anymore?
2) Is there any exercise I should be doing?
3) Should there have been a different course of treatment in the initial weeks?

Any information will be highly appreciated.

Thank you

[Michael L Gross, MD]

This is a fracture of the articular surface of the DIP joint of the thumb. On the images you provided, the fracture appears to involve about 40% of the articular surface with a reasonable amount of displacement. Although the bone will certainly heal, you may lose some motion and may be subject to post-traumatic arthritis in the future.  At this point, the fracture should be fairly well healed; I would likely institute a range of motion program and observe your progress.

[no55]

To see the links of the x-rays I've posted above, you just need to copy/paste the URL to the address bar of your browser but I will try to repost the pictures here under a different format:

Left thumb bottom aspect
[IMG]http://i44.tinypic.com/2mnq1af.jpg[/IMG]

Left thumb side aspect (as you look the hand from the top)
[IMG]http://i40.tinypic.com/10mihyd.jpg[/IMG]

[no55]

Thank you.