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Finger Fractures

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Phalangeal and metacarpal fractures of the hand — non-operative care and indications for fixation.

Updated Aug 2026
A hand-drawn illustration of a fractured finger bone.
X-ray showing a fracture pattern through a finger phalanx. Servier Medical Art / smart.servier.com, CC BY 4.0

What you're feeling

You might hear a snap or feel a sudden pop when the injury happens. This often occurs during a fall, a direct impact, or a sudden load on your hand. In that moment, sharp pain hits the affected finger or palm. Your hand may swell up quickly. You might see bruising develop within hours. The area can look deformed or bent in an unusual way.

Moving the injured finger feels difficult and painful. You may find yourself reluctant to use it at all. Simple tasks like gripping a cup or typing become hard. If the fracture involves the thumb or index finger, you might feel extra concern because these digits are crucial for daily function. For most metacarpal fractures (the bones in your palm), the injury is simple and stable. You will likely feel discomfort rather than severe instability.

In the first few days, pain is often worse at night or when you move the finger. Swelling peaks during this time. If you have an open fracture where the skin is broken, the pain may be more intense due to tissue damage. About one in four open fractures requires more than one procedure because of the severity of the crush or blood vessel injury. However, for most closed fractures, the acute pain begins to settle as healing starts.

Over the next few weeks, you will notice a gradual change. The sharp pain fades into a dull ache. Swelling goes down. You might start to regain some movement, though stiffness is common. For children, buddy taping (taping the injured finger to the healthy one next to it) helps support the bone while you heal. Most patients find that their well-being is minimally affected by the fracture itself once the initial shock passes. You will likely feel a sense of relief as the worst of the pain subsides and you can begin gentle care under our guidance.

What's actually happening

Your finger bones are small rods that give your hand its shape and strength. When you break one, the bone splits or cracks. This disrupts the smooth surface where bones meet at the joint. It also affects the tendons that pull your finger to bend and straighten it. Right now, your hand does not work normally because the broken pieces are unstable. They cannot support force or move smoothly together.

Think of your finger like a tent pole. If the pole is straight, it holds the tent up firmly. If the pole snaps or bends, the tent collapses or sags. Similarly, a broken finger bone loses its ability to support movement. The surrounding soft tissue becomes swollen and tight. This stiffness makes it hard to grip or pinch.

Healing requires the bone to knit back together. Your body builds new bone tissue to bridge the gap. For most simple breaks, this happens naturally. However, if the bone is displaced or unstable, it may heal in the wrong position. This can limit your movement later. In these cases, your surgeon may need to realign the pieces and hold them in place with pins or plates. This ensures the bone heals straight and strong.

Some injuries are more complex. Open fractures, where the skin is broken, carry a higher risk of infection and often require more than one surgery. A quarter of open finger fractures will likely need more than one surgical procedure. Injuries to the thumb and index finger are also more likely to undergo unplanned reoperation. These fingers are used constantly for fine tasks, so precise healing is critical.

Postoperative stiffness is a common challenge. After surgery for unstable fractures, 43% of patients experience some finger stiffness. This is why early, controlled movement is often part of the plan. Gentle motion helps prevent the joint from freezing up. It allows you to regain function while the bone continues to heal. Your surgeon will guide you through this process to balance stability with mobility.

What we can do about it

This guidance reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic. Most hand fractures are stable and heal well without surgery. We often treat these with simple measures like buddy taping or a splint. Children make up a large group of patients with these injuries, and most recover fully with non-surgical care. For adults, we may use a cast or splint if the bone pieces are aligned correctly. We monitor your progress with repeat X-rays to ensure the bones stay in place while they heal.

Surgery is recommended from the outset if your fracture is unstable, severely displaced, or involves the joint surface. We also consider surgery if you have an open wound or if the injury affects blood flow. In some cases, you might choose surgery even if non-operative care is possible, because you prefer to avoid pain or potential misalignment. Our goal is to restore your hand’s function and strength. For example, evidence shows that 92% of patients return to full function without complications at 10 weeks following injury with an evidence-based pathway for metacarpal fractures. We discuss these options with you so you can make an informed choice.

Both paths share the same priorities in the early weeks. We focus on controlling your pain and protecting the injury while it heals. You will need to keep the hand elevated and avoid using it for heavy tasks. As the bone begins to knit, we guide you through physiotherapy to restore movement. This staged return to activity helps prevent stiffness and ensures you regain full use of your hand. We tailor the therapy to your specific fracture type and healing progress.

What to expect

Most finger fractures heal well without surgery. Your surgeon will likely recommend buddy taping, where you tape the injured finger to the healthy one next to it. This keeps the bones aligned while they mend. For children, this non-surgical approach usually leads to good results. Even if the bone is displaced, taping often works well.

If your fracture is unstable or involves the thumb or index finger, you may need an operation. Your surgeon might use small screws or pins to hold the bone in place. This helps you regain normal grip strength and motion. Most people return to full function within 10 weeks. However, recovery is not always smooth. Stiffness is common, affecting about 43% of patients with unstable fractures treated with plates. You may also need a second surgery to remove hardware if it causes discomfort. This typically happens around two months after the first operation.

Open fractures, where the skin is broken, are more serious. About one in four of these cases requires more than one surgical procedure. This is especially true if the injury involves crushing or damage to blood vessels. Injuries to the thumb and index finger also carry a higher risk of needing unplanned reoperation compared to other fingers.

Healing takes time. You should expect some swelling and pain for the first few weeks. Gentle movement is key to preventing stiffness, but you must follow your surgeon’s advice on when to start. Most people can return to daily tasks and light work within a few weeks. Return to sports or heavy labor may take longer, depending on the finger involved. Thumb fractures often require operative intervention to ensure a quicker return to play.

While most outcomes are positive, be aware of the risks. Slow healing or healing in a poor position can occur. In rare cases, you might develop a new fracture at the original site if you had a previous injury there. Attend all follow-up appointments so your surgeon can monitor your progress with X-rays. Most fifth metacarpal fractures do not need repeated X-rays, but your surgeon will decide based on your specific case.

When to see someone

Seek urgent care if you have an open wound, visible deformity, numbness, tingling, or cannot move your finger. These signs need immediate assessment. Most finger breaks heal well without surgery. However, some complex injuries require prompt treatment to prevent stiffness or further damage. About one in four open fractures needs more than one operation. You should also see your GP or ask for a specialist review if your pain is not settling. Watch your progress week on week. If swelling, movement, or function are not improving as healing progresses, let your surgeon know. Early follow-up helps ensure you return to full function safely.

Reviewed by AI synthesis (v2) — pending human review · 18 May 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

Evidence & references

Overview

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • Most pediatric phalangeal fractures can be treated nonsurgically [14].
  • A small subset of pediatric phalangeal fractures benefits from surgical intervention [14].
  • A quarter of open finger fractures will likely need more than one surgical procedure [3].
  • Open finger fractures in more severely injured fingers are especially likely to need more than one surgical procedure due to crush or vascular impairment [3].
  • Taping finger fractures can be recommended irrespective of the degree of displacement or the need for reduction in children with displaced extra-articular phalangeal finger fractures [19].
  • External fixation is an efficient alternative treatment method for combined open fractures of the thumb metacarpal and trapezium, with encouraging short-term clinical and radiographic results [6].
  • Retrograde intramedullary screw (RIS) fixation in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications [20].
  • More high-quality studies are needed to fully examine retrograde intramedullary screw fixation as a modality for metacarpal fractures [20].
  • Intramedullary fixation is an approach reviewed for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis [23].
  • Surgeons who treat metacarpal and phalangeal fractures inevitably treat complications associated with these fractures [4].
  • A poorly functioning finger may represent a liability to the hand [16].
  • Achievement of union or improved alignment alone may not be sufficient to justify retention of a digit if it is poorly functioning [16].

Anatomy & Pathophysiology

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • Surgeons who treat metacarpal and phalangeal fractures inevitably treat complications associated with these fractures [4].
  • A poorly functioning finger may represent a liability to the hand [16].
  • Achievement of union or improved alignment alone may not be sufficient to justify retention of a digit [16].
  • Surgical treatment is usually indicated for fractures and dislocations of the base of the thumb metacarpal to restore the anatomy and biomechanics of the trapeziometacarpal joint [22].
  • Conservative treatment of base of thumb metacarpal fractures and dislocations often yields poor results [22].
  • Intramedullary fixation is an approach reviewed for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis [23].
  • Mini-external fixation and Kirschner wire internal fixation have similar effects on postoperative traumatic arthritis and postoperative hand functions in Bennett fracture treatment [25].
  • Each of eight patients treated with traction for hand fractures achieved a useful, painless range of motion while in traction and afterward [26].
  • Full use of the hand was obtained eight to ten weeks from the time of injury in patients treated with traction [26].
  • Both volar plating and external fixation can obtain a good range of motion at the proximal interphalangeal joint in unstable dorsal fracture-dislocations [33].
  • The pins and rubbers traction system (PRTS) significantly increases flexion forces of the proximal interphalangeal (PIP) joint [38].
  • The pins and rubbers traction system (PRTS) prevents narrowing of the PIP joint [38].
  • Most pediatric hand fractures can be treated by closed methods with immobilization for 3 to 4 weeks [41].
  • Children have a great potential for malalignment correction of hand fractures by remodeling with growth [41].
  • Osteochondral autograft from the hamate for treating partial defect of the proximal interphalangeal joint results in generally acceptable functional recovery and well-restored joint architecture [44].
  • Mini-external fixators (MEFs) are effective to establish union and correct alignment of the hand skeleton with minimal tissue trauma [45].
  • Mini-external fixators (MEFs) retain a good clinical outcome even in the most complex hand injuries [45].

Classification

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction [18].
  • A quarter of open finger fractures will likely need more than one surgical procedure [3].
  • Reoperation for open finger fractures is especially likely in more severely injured fingers due to crush or with vascular impairment [3].
  • Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone [12].
  • External fixation is an efficient alternative treatment method for combined open fractures of the thumb metacarpal and trapezium [6].
  • Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
  • The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups [10].
  • Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures [9].
  • Phalangeal fractures tend to deteriorate in total active motion (TAM) more than metacarpal fractures [13].
  • Taping finger fractures can be recommended irrespective of the degree of displacement or the need for reduction in children [19].
  • Patients with type 3 and 5 jersey finger fractures treated with buttress plating exhibited a functional distal interphalangeal joint range of motion [47].

Clinical Presentation

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction [18].
  • A quarter of open finger fractures will likely need more than one surgical procedure [3].
  • Open finger fractures requiring more than one surgical procedure are especially associated with more severely injured fingers, crush injuries, or vascular impairment [3].
  • Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone [12].
  • Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures [9].
  • The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups [10].
  • Most pediatric phalangeal fractures can be treated nonsurgically, but a small subset benefits from surgical intervention [14].
  • Isolated fifth metacarpal fractures can be managed definitively in the ED without further face to face review, with good patient satisfaction and acceptable functional results [29].
  • Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
  • Early diagnosis and appropriate treatment can allow athletes to return to play quickly after they sustain fractures or dislocations of the hand or wrist [11].

Investigations

  • Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures [9].

Treatment

  • The majority of hand fractures can be treated without surgery [1].
  • Surgery offers distinct advantages in properly selected cases of hand fractures [1].
  • Most hand fractures can be managed successfully without operation [5].
  • Conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures [5].
  • A quarter of open finger fractures will likely need more than one surgical procedure [3].
  • Reoperation for open finger fractures is especially likely in more severely injured fingers due to crush or with vascular impairment [3].
  • External fixation is an efficient alternative treatment method for combined open fractures of the thumb metacarpal and trapezium [6].
  • Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
  • The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups [10].
  • Most pediatric phalangeal fractures can be treated nonsurgically [14].
  • A small subset of pediatric phalangeal fractures benefits from surgical intervention [14].
  • With non-operative treatment of fractures of the neck of the fifth metacarpal, similar results were achieved with dorsal angulation either above or below 30 degrees [17].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture [18].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the degree of displacement [18].
  • Treatment of fractures of the proximal phalanx and metacarpals is based on the difficulty in maintaining fracture reduction [18].
  • Buddy taping after reduction of displaced extra-articular phalangeal finger fractures in children can be recommended irrespective of the degree of displacement or the need for reduction [19].
  • Retrograde intramedullary screw (RIS) fixation in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications [20].
  • The vast majority of metacarpal fractures in athletes are managed nonoperatively with protective bracing and rapid return to play [30].
  • Patients with a single displaced spiral and/or oblique finger metacarpal shaft fracture treated with unrestricted mobilization have outcomes comparable to those treated operatively [31].
  • Operative treatment of single displaced spiral and/or oblique finger metacarpal shaft fractures may result in metacarpal shortening [31].
  • Intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic advantage compared to conservative treatment [32].
  • Intramedullary splinting for displaced fractures of the little finger metacarpal neck does not offer a functional advantage compared to conservative treatment [32].
  • Surgical indications for fractures or fracture-dislocations include displaced articular fragments [36].
  • Surgical indications for fractures or fracture-dislocations include rotational misalignment [36].
  • Surgical indications for fractures or fracture-dislocations include significant digit angulation or shortening [36].
  • Surgical indications for fractures or fracture-dislocations include irreducible dislocation [36].
  • Surgical indications for fractures or fracture-dislocations include significant injury to the joint supporting structures [36].
  • Buddy taping is a non-inferior treatment modality for most paediatric finger fractures compared to splint immobilization [37].
  • Non-locking plates are appropriate for most metacarpal and phalangeal fractures necessitating plate fixation [39].
  • Social deprivation influences the pattern of hand fractures [46].
  • Social deprivation influences the management of hand fractures [46].

Complications

  • A quarter of open finger fractures require more than one surgical procedure [3].
  • Reoperation is especially likely in more severely injured fingers due to crush injury or vascular impairment [3].
  • Surgeons treating metacarpal and phalangeal fractures inevitably encounter associated complications [4].
  • Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone [12].
  • Phalangeal fractures tend to deteriorate in total active motion (TAM) more than metacarpal fractures [13].
  • A poorly functioning finger may represent a liability to the hand, and achieving union or improved alignment alone may not justify retention of the digit [16].
  • Retrograde intramedullary screw fixation in metacarpal fractures is associated with minimal complications [20].
  • Transcarpal migration of a broken Kirschner wire can cause ulnar neurapraxia [28].

Recovery

  • The majority of hand fractures can be treated without surgery, though surgery offers distinct advantages in properly selected cases [1].
  • Early diagnosis and appropriate treatment can allow athletes to return to play quickly after they sustain fractures or dislocations of the hand or wrist [11].
  • A quarter of open finger fractures will likely need more than one surgical procedure, especially in more severely injured fingers, due to crush or with vascular impairment [3].
  • Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation [7].
  • Both cases of combined dislocation of the trapezoid and finger carpometacarpal joints demonstrate similar mechanisms resulting in nearly identical wrist injuries with good short-term functional outcomes when injuries are quickly recognized and appropriately addressed at initial surgery [15].
  • A poorly functioning finger may represent a liability to the hand, and achievement of union or improved alignment alone may not be sufficient to justify retention of the digit [16].
  • With non-operative treatment of fractures of the neck of the fifth metacarpal, similar results were achieved with dorsal angulation either above or below 30 degrees [17].
  • The patient regained satisfactory grip and thumb function with minimal donor site morbidity following functional reconstruction of a subtotal thumb metacarpal defect with a vascularized medial femoral condyle flap [21].
  • Each of the eight patients in the traction study achieved a useful, painless range of motion while in traction and afterward, and full use of the hand was obtained eight to ten weeks from the time of injury [26].
  • The only variables that lessen the return-to-play time for metacarpal fractures in the National Football League are involvement of lesser digit metacarpals and operative intervention for treatment of thumb metacarpal fractures [27].
  • DEF provides excellent functional results for closed phalangeal fractures at the PIP joint, with a low incidence of postoperative complications similar to other commonly used surgical techniques [42].
  • Recent reports confirm that small amounts of metacarpal shortening or dorsal angulation cause minimal functional impairment, and early motion of adjacent joints in closed simple metacarpal fractures expedites recovery of motion and strength without adversely affecting fracture alignment [43].

Key Evidence

  • [L5] The majority of hand fractures can be treated without surgery, though surgery offers distinct advantages in properly selected cases. [1] (10.1016/j.jhsa.2013.02.017)
  • [L3] A quarter of open finger fractures will likely need more than one surgical procedure, especially in more severely injured fingers, due to crush or with vascular impairment. [3] (10.1177/15589447211043191)
  • [L5] Surgeons who treat metacarpal and phalangeal fractures inevitably treat complications associated with these fractures. [4] (10.1016/j.hcl.2010.01.005)
  • [L5] Most hand fractures can be managed successfully without operation, and conservative functional techniques are the optimum treatment for the majority of patients with single metacarpal fractures. [5] (10.1177/1753193420928820)
  • [L4] Short-term clinical and radiographic results encouraged the authors about the efficiency of external fixation as an alternative treatment method for combined open fractures of the thumb metacarpal and trapezium. [6] (10.1007/s11552-007-9026-6)
  • [L4] Patients with combined ring and little finger carpometacarpal joint fracture-dislocations have similar functional outcomes to patients with only a little finger carpometacarpal joint fracture-dislocation. [7] (10.1177/1753193414562706)
  • [L1] Only two studies were found on the diagnostic accuracy of history taking for hand and wrist fractures. [9] (10.1186/s12891-019-2988-z)
  • [L4] The frequency, pattern, and treatment of pediatric hand fractures vary among different age groups. [10] (10.1177/1558944719900565)
  • [L5] Early diagnosis and appropriate treatment can allow athletes to return to play quickly after they sustain fractures or dislocations of the hand or wrist. [11] (10.1016/j.csm.2016.05.005)
  • [L2] Patients undergoing surgery for metacarpal or proximal/middle phalangeal fractures are not at greater risk for infection based on the diagnosis of open fracture alone. [12] (10.1016/j.jhsa.2018.04.032)
  • [L2] The phalangeal fractures tend to deteriorate %TAM than metacarpal fractures. [13] (10.1016/s0363-5023(11)60047-6)
  • [Paper] Most pediatric phalangeal fractures can be treated nonsurgically, but a small subset benefits from surgical intervention. [14] (10.1016/j.jhsa.2025.08.015)
  • [Case_report] Both cases demonstrate similar mechanisms resulting in nearly identical wrist injuries with good short-term functional outcomes when injuries are quickly recognized and appropriately addressed at initial surgery. [15] (10.1016/j.jhsa.2010.06.005)
  • [L5] A poorly functioning finger may represent a liability to the hand, and achievement of union or improved alignment alone may not be sufficient to justify retention of the digit. [16] (10.2106/00004623-200506000-00028)
  • [L3] With non-operative treatment of fractures of the neck of the fifth metacarpal, similar results were achieved with dorsal angulation either above or below 30 degrees. [17] (10.1016/j.injury.2008.03.016)
  • [L5] Treatment of fractures of the proximal phalanx and metacarpals is based on the presentation of the fracture, degree of displacement, and difficulty in maintaining fracture reduction. [18] (10.5435/00124635-200810000-00004)
  • [L1] With the current data, we can conclude that taping these finger fractures can be recommended irrespective of the degree of displacement or the need for reduction. [19] (10.1177/17531934241293338)
  • [L2] RIS use in metacarpal fractures appears to provide adequate stability with satisfactory clinical outcomes and minimal complications, although more high-quality studies are needed to fully examine this modality. [20] (10.1177/1558944720988073)
  • [Case_report] The patient regained satisfactory grip and thumb function with minimal donor site morbidity. [21] (10.1016/j.jhsa.2014.06.002)
  • [L4] Surgical treatment is usually indicated to restore the anatomy and biomechanics of the trapeziometacarpal joint, as conservative treatment often yields poor results. [22] (10.1177/1753193414554357)
  • [L5] The article reviews the background, biomechanics, applications, techniques, outcomes, and costs of this approach for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis. [23] (10.1016/j.jhsa.2023.08.011)
  • [L1] Both fixations have similar effects on postoperative traumatic arthritis and postoperative hand functions. [25] (10.1016/j.otsr.2012.07.015)
  • [L4] The only variables that lessen the return-to-play time are involvement of lesser digit metacarpals and operative intervention for treatment of thumb metacarpal fractures. [27] (10.1016/j.jhsa.2022.01.011)
  • [L4] The mechanism in this case was purely traumatic without predisposing causes such as inflammatory arthropathy or distal radius fracture. [28] (10.1177/1753193408102118)
  • [L4] Isolated fifth metacarpal fractures can be managed definitively in the ED without further face to face review, with good patient satisfaction and acceptable functional results. [29] (10.1007/s11552-015-9749-8)
  • [L5] The vast majority of metacarpal fractures in athletes are managed nonoperatively with protective bracing and rapid return to play. [30] (10.1016/j.hcl.2012.05.028)
  • [L2] Patients with a single displaced spiral and/or oblique finger metacarpal shaft fracture treated with unrestricted mobilization have outcomes comparable to those treated operatively, despite metacarpal shortening. [31] (10.2106/jbjs.22.00573)
  • [L2] Intramedullary splinting for displaced fractures of the little finger metacarpal neck offers an aesthetic, but not a functional advantage compared to conservative treatment. [32] (10.1177/1753193410377845)
  • [L4] Both methods can obtain a good range of motion at the proximal interphalangeal joint. [33] (10.1177/17531934211059300)
  • [L5] Surgical indications for fractures or fracture-dislocations include displaced articular fragments, rotational misalignment, significant digit angulation or shortening, irreducible dislocation, and significant injury to the joint supporting structures. [36] (10.1016/j.csm.2014.09.002)
  • [L1] Buddy taping is a non-inferior treatment modality for most paediatric finger fractures compared to splint immobilization. [37] (10.1177/1753193418822692)
  • [L4] The PRTS significantly increases flexion forces of the PIP joint and prevents narrowing of the joint. [38] (10.1007/s00402-007-0526-1)
  • [L5] Non-locking plates are appropriate for most metacarpal and phalangeal fractures necessitating plate fixation. [39] (10.1016/j.jhsa.2011.09.023)
  • [L5] Most pediatric hand fractures can be treated by closed methods with immobilization for 3 to 4 weeks, as children have a great potential for malalignment correction by remodeling with growth. [41] (10.1016/j.hcl.2005.10.001)
  • [L2] DEF provides excellent functional results for closed phalangeal fractures at the PIP joint, with a low incidence of postoperative complications similar to other commonly used surgical techniques. [42] (10.1177/17531934251350453)
  • [L5] Recent reports confirm that small amounts of metacarpal shortening or dorsal angulation cause minimal functional impairment, and early motion of adjacent joints in closed simple metacarpal fractures expedites recovery of motion and strength without adversely affecting fracture alignment. [43] (10.1097/01.blo.0000205888.04200.c5)
  • [L4] The functional recovery is generally acceptable, with a well-restored joint architecture. [44] (10.1016/j.jhsa.2021.11.007)
  • [L4] The findings demonstrate the efficacy of versatile MEFs to establish union and correct alignment of hand skeleton with minimal tissue trauma while retaining a good clinical outcome even in the most complex injuries. [45] (10.1016/j.jhsa.2008.12.017)
  • [L3] Social deprivation influences both the pattern and management of hand fractures. [46] (10.1177/1753193410381823)
  • [L4] Patients with type 3 and 5 injuries exhibited a functional distal interphalangeal joint range of motion. [47] (10.1016/j.jhsa.2025.07.038)

References

[1] Hand Fractures: A Review of Current Treatment Strategies. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.02.017 [3] Reoperation After Operative Treatment of Open Finger Fractures. HAND. 2022. DOI: 10.1177/15589447211043191 [4] Complications After the Fractures of Metacarpal and Phalanges. Hand Clinics. 2010. DOI: 10.1016/j.hcl.2010.01.005 [5] Current methods, outcomes and challenges for the treatment of hand fractures. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420928820 [6] Management of Combined Open Fractures of Thumb Metacarpal and Trapezium (Surgical Tip). HAND. 2007. DOI: 10.1007/s11552-007-9026-6 [7] Fracture-dislocations of the carpometacarpal joints of the ring and little finger. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414562706 [9] Diagnostic accuracy of history taking, physical examination and imaging for phalangeal, metacarpal and carpal fractures: a systematic review update. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-019-2988-z [10] Frequency, Pattern, and Treatment of Hand Fractures in Children and Adolescents: A 27-Year Review of 4356 Pediatric Hand Fractures. HAND. 2020. DOI: 10.1177/1558944719900565 [11] Return to Play After Hand and Wrist Fractures. Clinics in Sports Medicine. 2016. DOI: 10.1016/j.csm.2016.05.005 [12] Comparison of Open and Closed Hand Fractures and the Effect of Urgent Operative Intervention. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.04.032 [13] Predictors of the Postoperative Range of Finger Motion for Comminuted Hand and Finger Fractures Treated with a Titanium Plate. The Journal of Hand Surgery. 2011. DOI: 10.1016/s0363-5023(11)60047-6 [14] Pediatric Finger Fractures: Preventing Big Problems After Small Fractures. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.08.015 [15] Combined Dislocation of the Trapezoid and Finger Carpometacarpal Joints—The Steering Wheel Injury: Case Report. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.06.005 [16] MALUNION AND NONUNION OF THE METACARPALS AND PHALANGES. The Journal of Bone and Joint Surgery-American Volume. 2005. DOI: 10.2106/00004623-200506000-00028 [17] Effects of fusion angle on functional results following non-operative treatment for fracture of the neck of the fifth metacarpal. Injury. 2008. DOI: 10.1016/j.injury.2008.03.016 [18] Fractures of the Proximal Phalanx and Metacarpals in the Hand: Preferred Methods of Stabilization. Journal of the American Academy of Orthopaedic Surgeons. 2008. DOI: 10.5435/00124635-200810000-00004 [19] Buddy taping after reduction of displaced extra-articular phalangeal finger fractures in children: a randomized controlled trial. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241293338 [20] Retrograde Intramedullary Screw Fixation for Metacarpal Fractures: A Systematic Review. HAND. 2021. 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