Hand > Finger Fracture > Treatments

   Closed Reduction, Pinning

Treatment Introduction

Based on the nature and location of your finger fracture, your physician may inject a local anesthetic directly into your finger or hand to aid in performing a closed reduction. Once this has been done, the fracture will be reduced, or placed back in its normal position, by putting gentle pressure on the joint and moving the parts together. After a closed reduction has been performed, the fracture still may be unstable. If this is the case, the fracture may need to be stabilized using external pins or wires that are passed through the skin and fixed to the finger bones or screws and plates may be necessary depending on the fracture. There are three types of pinning that can be used: direct pinning, intramedullary fixation, and fixation to adjacent bone.

The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   Make sure you have received any equipment you will need when you get home from the hospital. You should receive prescriptions for these items from your doctor when your surgery is scheduled.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   To reduce the risk of infection, improve healing, and decrease complications, try to quit smoking or decrease the amount you smoke. In general, smokers have a higher infection and complication rate overall.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your closed reduction and pinning of your finger fracture. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery. Be sure to ask your physician or an assistant about this. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made and paperwork is completed. You will wear a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant, and meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will be taken to the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because you may be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Surgery Procedure

The procedure is usually performed under a regional anesthetic which, means that they give you numbing medicine to make your hand or arm go to sleep. You can stay awake for the procedure or receive medicine to relax. If enough relaxing medicine is given, you can fall asleep so that you do not have any memory of the actual procedure.

You usually spend 1-2 hours in recovery room waiting for the medicine that relaxed you to wear off. The more sedation that you receive, the longer you will spend in recovery after the procedure. Most doctors also use numbing medicine so that your hand may be asleep after you wake up. The numbing medicine can last for 2-6 hours. When the numbing medicine wears off the pain begins and you are given oral medication to reduce your discomfort.

After closed reduction and pinning of a finger fracture, the length of time that you will need to keep the splint on varies according to the severity of your injury and which bone is affected. You should return to the doctor approximately 8-10 days after the procedure to have the stitches removed. During this time you can not get the area wet. When taking a shower you can place a large plastic bag on your arm with a rubber band at the top part of your arm. Hold your elbow over your head so that water does not role down your shoulder and into the bag. Commercially-made bags, which function in a similar way, can be purchased at a surgical supply store. Applying ice to the finger is helpful for the first two to three days. The cold causes the blood vessels to constrict (shrink). This reduces blood flow to the hand and therefore helps the body stop the internal bleeding which occurs from the torn ligament. This bleeding is seen through the skin which you call a bruise. The less bleeding there is, the less inflammation there will be, which means a quicker recovery and return to activities. Keeping the hand elevated also helps because it reduces blood flow to the hand and limits swelling. Swelling in the hand causes the pressure in the tissue to increase. Your brain interprets this pressure as pain, therefore, the more swollen the hand becomes, the more painful. By elevating the hand the fluid which has collected there runs down into the forearm just like a river runs down hills. This reduces the swelling of the hand and gets rid of the annoying throbbing that occurs after finger injuries.

Following closed reduction and pinning of a finger fracture, your physician may suggest that you begin a program of range of motion while with other types of fractures immobilization is continued until bone healing has occurred. Your physician and physical therapist will instruct you on the proper course of rehabilitation. When you can start these exercises depends on the nature and severity of fracture you have suffered and the type of fixation that was used to stabilize it. For example, direct pinning to stabilize some fractures of the phalanges can allow you to begin range of motion exercises almost immediately. Conversely, some fractures that involve the metacarpal bones require that you wait up to three weeks before motion is started. Depending on the severity of your injury, return of full joint motion after a finger fracture can take as long as several months. During this time swelling and stiffness may recur. A return to sports or strenuous physical activity should not be rushed, and should only be done after consultation with your physician.

Though finger fractures are contact injuries that often cannot be avoided, you can take steps to minimize your risk of suffering a fracture. If you play contact sports such as football, hockey, or lacrosse, make sure you wear padding that protects your hands and fingers. Never use old, worn-out pads that have lost their stiffness. Maintaining hand and finger strength and coordination also can help prevent some finger injuries. Ask your physical therapist for a specific program of exercises.