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Tiny old fracture
Hi! My name is subodh. I used to play a lot of basketball in my country a lot. About 7 months ago I had sprained my finger and I myself had immobilized it using a buddy strap for 3-4 weeks. the proximal phalanx joint was stiff. i went to see the doctor but he did not recommend x-ray..he suggested i rely on physiotherapy so he suggested some exercises. It has been about 7 months and the finger still is stiff ..but it only hurts a bit when i try to touch the upper part of my palm with the tip of the finger(doesnt hurt much but gets difficult and i am not able to touch the upper palm without external pressure to the finger(ring finger ..it is..and left hand)...i recently decided to x-ray my that ring finger(as i had hurt my ankle as well recently)...the doctor here spotted a very small fracture in the proximal phalanx...and she told me that since it was a very old fracture she could not do anything. she has referred me to a plastic surgeon..(i am not sure whether it is covered in my insurance so i am reluctant to see him)..what can be done about such small fractures? will i be able to gain full ROM through physiotherapy only..(albeit it might take some time)?
Hi Subodh,
I don’t think that you should be going to Plastic surgeon at all, unless you have a scar tissue which is cosmetically incorrect.
I feel we should be treating this fracture as one which is diagnosed recently. We should try for conservative management like buddy strapping for 3 to 4 weeks and then re-evaluate your fracture status.
Imaging of the involved joint at end of 4 weeks is a must.
What physical therapy have they planned?
When do they want start?
Bye.
I don’t think that you should be going to Plastic surgeon at all, unless you have a scar tissue which is cosmetically incorrect.
I feel we should be treating this fracture as one which is diagnosed recently. We should try for conservative management like buddy strapping for 3 to 4 weeks and then re-evaluate your fracture status.
Imaging of the involved joint at end of 4 weeks is a must.
What physical therapy have they planned?
When do they want start?
Bye.
Dear Jain..thanks for the prompt replies again and again. I am a right handed person..I did try to see the plastic surgeon but due to New Year he was unavailable+ it has been confirmed that my insurance does not cover plastic surgery so I will not be seeing plastic surgeon anytime soon(planning to see him next after my paycheck arrives!!). The plan for my finger was simply buddy strapping at the moment. How effective can a buddy strapping can be at this juncture when the fracture is 7-8 months old? Please suggest...(PS: I really love this interaction in times of misery)...thank you so much JainMD
Hi,
I feel nice that I could be of some help to you. As you have described your fracture is closed one.
Which is your dominant hand? Is the fracture on the same hand? There is no foreign body being reported on X-ray which rules out foreign body as the cause for non-healing.
What is the line of management planned?
Did you discuss this with plastic surgeon?
Most fractures can be treated non-surgically with closed reduction, splinting, and early motion.
Non-displaced and impacted transverse fractures of the phalanges are managed ideally with buddy taping, in which 2 fingers are taped together so that 1 acts as a splint for the other. The fracture must truly be stable with minimal angulations in any plane.
Immobilize unstable closed fractures for 3 to 4 weeks.
Physical therapy to increase the range of motion of joint is important.
When have planned for physical therapy?
Keep me informed.
Bye.
I feel nice that I could be of some help to you. As you have described your fracture is closed one.
Which is your dominant hand? Is the fracture on the same hand? There is no foreign body being reported on X-ray which rules out foreign body as the cause for non-healing.
What is the line of management planned?
Did you discuss this with plastic surgeon?
Most fractures can be treated non-surgically with closed reduction, splinting, and early motion.
Non-displaced and impacted transverse fractures of the phalanges are managed ideally with buddy taping, in which 2 fingers are taped together so that 1 acts as a splint for the other. The fracture must truly be stable with minimal angulations in any plane.
Immobilize unstable closed fractures for 3 to 4 weeks.
Physical therapy to increase the range of motion of joint is important.
When have planned for physical therapy?
Keep me informed.
Bye.
Dear Jain..thnx for the replies. my report says that ..the fracture in question is "........tender head of proximal phalanx..restricted flexion...no neurovascular deficits...undisplaced # of head of proximal phalanx of left ring finger.." Please suggest.
Hi,
It is not that your fracture has not healed; it is that your fracture still persists.
It might that your fracture has healed, but due to repeated movements and may be improper healing it has persisted.
No, fractures are not treated by plastic surgeon anywhere in the world.
No it is not going to affect you in future.
Can you tell me what class of fracture it is?
Growth plate fractures are usually classified as per Salter-Harris type of classification.
What grade of fracture you have?
Bye.
It is not that your fracture has not healed; it is that your fracture still persists.
It might that your fracture has healed, but due to repeated movements and may be improper healing it has persisted.
No, fractures are not treated by plastic surgeon anywhere in the world.
No it is not going to affect you in future.
Can you tell me what class of fracture it is?
Growth plate fractures are usually classified as per Salter-Harris type of classification.
What grade of fracture you have?
Bye.
Dear JainMD..thanks for the prompt reply. I am currently livingAdvanced care directives in Sydney. I am going to just have a chat with the plastic surgeon tomorrow and get his opinoin (but i do not think I would opt for a plastic surgery
at the moment because I guess it is not covered through my insurance). It is just surprising as to how the fractureFractures across a growth plate could have persisted for so long. I am getting worried a bit about when it will heal. i understand that there are some tricky issues related to fracturesFractures across a growth plate..but it freaked me to know that it had remained there for so many months. So are fracturesFractures across a growth plate dealt by plastic surgeons? This prolonged episode has got me worried a bit. nearly eight months and the fractureFractures across a growth plate is still there. Is there a possibility that it might trouble me badly in the future?
at the moment because I guess it is not covered through my insurance). It is just surprising as to how the fractureFractures across a growth plate could have persisted for so long. I am getting worried a bit about when it will heal. i understand that there are some tricky issues related to fracturesFractures across a growth plate..but it freaked me to know that it had remained there for so many months. So are fracturesFractures across a growth plate dealt by plastic surgeons? This prolonged episode has got me worried a bit. nearly eight months and the fractureFractures across a growth plate is still there. Is there a possibility that it might trouble me badly in the future?
Dear JainMD..thanks for the prompt reply. I am currently living in Sydney. I am going to just have a chat with the plastic surgeon tomorrow and get his opinoin (but i do not think I would opt for a plastic surgery at the moment because I guess it is not covered through my insurance). It is just surprising as to how the fracture could have persisted for so long. I am getting worried a bit about when it will heal. i understand that there are some tricky issues related to fractures..but it freaked me to know that it had remained there for so many months. So are fractures dealt by plastic surgeons? This prolonged episode has got me worried a bit. nearly eight months and the fracture is still there. Is there a possibility that it might trouble me badly in the future?
Hi Subodh,
Are you from India?
Well it seems your ulnar nerve is affected along its distribution as you are not able to touch finger tips and ulnar nerve supplies intrinsic muscles of hand.
Your pain may also be related to tiny fracture which is detected now. I think apart from immobilizing the proximal interphalangeal joints again, you should be taking calcium and Vit C supplements to fasten the recovery.
Yes, you would be able to gain full ROM with physiotherapy, rest to the part, analgesics and steam fomentation to the part.
Keep me informed about your decision and line of management.
Bye.
Are you from India?
Well it seems your ulnar nerve is affected along its distribution as you are not able to touch finger tips and ulnar nerve supplies intrinsic muscles of hand.
Your pain may also be related to tiny fracture which is detected now. I think apart from immobilizing the proximal interphalangeal joints again, you should be taking calcium and Vit C supplements to fasten the recovery.
Yes, you would be able to gain full ROM with physiotherapy, rest to the part, analgesics and steam fomentation to the part.
Keep me informed about your decision and line of management.
Bye.
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