broken finger still crooked after cast off (pictures + x-rays)

[harpoon_5]

Hello, 22 y/o male here
fell down and jammed my left ring finger 1 month ago, went to ER and they said it was a fracture of the base of the proximal IV phalange
posterior-anterior x-ray a few hours after, finger in middle of picture
http://i19.photobucket.com/albums/b194/harpred/beforepa.jpg

i got a cast for one month (pinky and ring finger together, partially flexed) after one month i took it off and was dissapointed to see that the affected finger was crooked
http://i19.photobucket.com/albums/b194/harpred/after.jpg
normal right hand for reference
http://i19.photobucket.com/albums/b194/harpred/normal.jpg

the finger does not really hurt on palpation but i cannot flex it beyond a certain point before i am stopped by pain, if i extend it fully or flatten my hand out on a surface, it does appears straighter

x-rays after 1 month
medial
http://i19.photobucket.com/albums/b194/harpred/aftermedial.jpg
posterior anterior
http://s19.photobucket.com/albums/b194/harpred/?action=view&current=afterpa.jpg
other than it being visibly crooked on the PA view, the radiologist said she actually saw it was part of a spiral fracture, and also pointed out a small sharp process jutting out on the medial (left on the xray) side of the distal phalange
her full report states "set almost axially. Callus barely visible, surrounding bone atrophied"

she said that maybe the atrophied side will build up a bit more and the distal one will atrophy or something, and that it might straighten by itself because im young, but looking at it now, i dont see how its possible

what do you think? im trying to get a consult, what are my treatment options... i cant imagine how re-breaking it would help, i am also in medical school and i really want my finger back to normal :) thanks in advance

[Emily0820]

I had a complete break in the middle bone, diagonally across the entire bone. And mine is a little crooked, and I cant straighten it all the way. But if you can use it, then I wouldn't go through surgery. Waste of money and painful. But if you're having difficulty with motion, physical therapy is always an option

[harpoon_5]

no, it did not staighten now, i have function, but its quite obvious that its crooked due to the rotational deformity when i flex the fingers, its called scissoring.

i also spoke to a hand surgeon and he said they would have to perform an osteostomy - basically, cut the bone in half, rotate it into position, and, because its so near my joint (the knuckle joint), they would have to put pins horizontally through the two pieces of bone, AND into the knuckle joint, to immobilize it completely for a month before they take the pins out again. He said, if i can use the finger, then not to bother, because theres a chance that i may lose function of the joint

with you, i woudlnt bother, you're lucky its only your finger tip.. i presume they would also have to put pins through your finger tip joint to set it as well but i dont know what ur doctor said. the easiest case is if the spiral fracture was right in the middle of a longer section of finger, that way they can break it open and re-align the two pieces and put pins just to connect the two pieces and not have to put the pins all the way into the next joint
hope that helps and good luck

[UVAgirl2009]

Hi!

I currently have a similar fracture, only it is at the fingertip. It can extend straight and I can make a loose fist, but I have a rotational deformity according to the doctors. The doctor gave me the option of letting it heal on its own crooked or surgery to set it straight with pins. How did your finger heal? Did it straighten at all?

Thanks!

[harpoon_5]

i forgot to ask, most importantly, would splinting it in a straightened out angle to oppose the lateral bend help?? or should i just concentrate on trying to get full flexure back...