A/Prof Cristina Morganti-Kossmann
August 5, 2020

Finger fractures are not insignificant injuries

Our hands are the best tool we have, being partially responsible for the superior evolutionary status we humans have achieved. This was driven by the ability of hominids to acquire the throwing and clubbing grip provided by anatomical remodelling of the hand and specifically with thumb opposition.

We use our hands for countless daily activities, in labour and sport. Due to the extensive use of our hands and fingers, injuries and fractures of the fingers are common. Fingers fractures are very painful due to the abundance of nerve endings present in this region. These nerve endings provide us with a high level of sensation, an essential feature required for fine manual movements.

Because of the important role our hands play in our life, finger fractures can severely impair our daily activities and need to be repaired quickly and efficiently. Imagine a pianist with the incorrect healing of a finger fracture; this could end the musician’s career. Or think of a factory worker occupied in fine machinery constructions; a complex finger fracture will severely affect the worker’s capacity to continue their employment.

In adults and adolescents, fractures of the fingers are more often found in sports injuries but can also occur due to other physical traumas. With improper treatment or with the occurrence of complications, finger fractures can lead to poor hand function, chronic pain, stiffness and deformity.

Finger fractures as result of sport injury

Where do finger fractures occur?
Looking at the anatomical details, the hand has 14 phalanges, which are tubular bones extending from the metacarpal bones to the fingertips. Finger phalanges include the proximal, middle and distal phalanx. Besides the thumb having only two, all other fingers have three phalanges.

A finger fracture can occur in any of these bones, at the distal, middle or proximal phalanx. They can display different characteristics, which are classified to distinguish transverse, oblique spiral and comminuted fracture types. Within the phalanx, fractures may be located in the neck, just below the head (more frequently), along the shaft or at the base.
Anatomy of phalanges - fingers
Depending on the energy applied to the hand, finger fractures may also involve injuries to the cartilage, joint capsule, tendons, ligaments, palmar fascia, the dorsal hood as well as the nerves. Such a set of injuries increases the seriousness. The medical examination of the hand and fingers is quite complex due to the large number of joints that are tested one after the other. A full description of the hand and wrist examination can be found here. The treatment of a finger fracture can be achieved conservatively, however, a complex fracture presenting bone displacement, comminution or when combined with additional structural damage, demands surgical intervention. In the pathology published on our website, you can find all types of treatment and rehabilitation.

Preventing hand injuries in the workplace
The Department of Employment of the Australian government is investing huge efforts on hand safety awareness to prevent hand injuries, mostly within the building and construction industry. In a case study, a construction company distributed a hand safety awareness poster titled ‘Five Steps to Hand Safety’ to all of its sites. The poster included statistics regarding the number of hand injuries sustained by their own workforce and provided steps to follow in order to reduce the incidence of injuries. The emphasis on awareness also encourages the use of personal protective equipment and the specific glove types for each work activity. Other posters utilised graphic images of accidents that had occurred at the workplace to show the potential impact hand injuries have on workers.

Finger fractures often happen in the workplace

Cases of hand injury compensation
Hand injuries and fractures occupy a significant place within the medico-legal space, in particular from workplace injuries. The compensation for such injuries can reach a substantial amount when the damage is so severe to compromise the return to work or require an extended sick leave.

Australian workers compensation
According to the Safe Work Australia Australian Workers’ Compensation Statisticsin 2017-18injuries and diseases to the hands and fingers comprised 13.5% of injuries, namely 14,440 out of 107,335 in total. These included a variety of mechanisms, from motor vehicle accidents to being hit by moving objects, falls, and body stressing.

Case study of finger injury in Australia
In Blacktown, NSW, a man was awarded over $180,000 after suffering injuries to his right hand and fingers following a workplace injury. He was using a bench saw to cut a piece of metal when a smaller piece flung out of the machine, causing the partial amputation of his right index finger. This gentleman suffered injuries to four of his fingers on his right hand, undergoing plastic surgery for the finger that was partially amputated. He continued to suffer stiffness in his hands although the pain had dissipated.

Finger amputation

Following a medico-legal assessment, he was found to have a whole person impairment greater than 15%. A claim for work injury damages was commenced, which was eventually taken to a settlement conference. A compensation agreement of $180,000 was reached, of which $160,000 was for damages (economic loss) and a payment of $23,650 for whole person impairment.

Large compensation cases in the US
In the US, monetary compensation for hand injuries can reach a very high amount. The AllLAW website reported a few examples of compensation due to finger injuries:

* An $8M verdict for plaintiff who lost three fingers requiring 12 surgeries due to defective design of conveyor belt;
* An $200,000 for plaintiff who suffered a broken pinky in a physical dispute and could not work for eight months;
* An $18,500 settlement for plaintiff who suffered crush injuries to fingers and hand at daycare requiring plastic surgery.


Finger fractures anatomy

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