Thumb fractures can be of varying severity; in some cases it is a simple and clear break, but in other cases they involve the joint, have many fragments and must be reduced with surgery. Since thumb injuries can leave life-long consequences that interfere with simpler actions, such as eating and working, it is imperative that any injury is dealt with seriously. Learn about the symptoms of a thumb fracture and what to expect in terms of care and treatments to heal the injury properly.
Steps
Part 1 of 3: Identifying a Fractured Thumb
Step 1. Pay attention to severe pain in the thumb
After a fracture, it is perfectly normal for the finger to hurt a lot, because the bone is surrounded by nerves. When the bone breaks, it irritates and compresses the surrounding nerve endings thus causing pain. If you don't feel severe pain following a thumb injury, there's a chance it isn't broken.
- You may also feel pain from touching or trying to bend your thumb.
- Usually, the closer the painful area is to the joint between thumb and hand (ie, near the webbed part between thumb and forefinger), the greater the risk of complications.
Step 2. Look for any deformities at the trauma site
You should evaluate whether or not the thumb looks normal. Do you have the impression that it is bent at an abnormal angle or twisted in a strange way? Also check for bones protruding from the skin. If you notice these characteristics, your thumb is likely to be fractured.
The finger may be bruised, which means that the capillaries in the tissue have broken off
Step 3. Try to move it
If it were broken, the movement would generate excruciating pain. The ligaments that connect the bones would not function properly, hampering the mobility of the finger.
In particular, see if you can move it backwards; if you can do it painlessly, you've probably suffered a sprain and not a fracture
Step 4. Pay attention to the feeling of numbness
In addition to pain, compressed nerves can prevent tactile sensitivity; the thumb may also become cold because a fracture triggers severe tissue swelling causing the blood vessels to become compressed and unable to supply the area.
The thumb may turn bluish if it does not receive blood or is limited in quantity
Step 5. Look for edema
When a bone breaks, the surrounding tissues swell as a reaction to inflammation. The finger should begin to swell within 5-10 minutes of the injury and then become stiff.
The swelling may extend to the closest fingers as well
Part 2 of 3: Bringing the Thumb to a Doctor's Attention
Step 1. Go to your family doctor or emergency room
If you are concerned that it is a fracture, you should go to the hospital so that an orthopedist can take care of the injury. If you wait too long, the stiffness caused by edema will make realignment more complex, with the risk of the finger being permanently bent.
- Also, in children a broken thumb can permanently affect their growth by damaging the growth plates.
- You should go to the emergency room for a correct diagnosis even if you think it is a sprain (tear of the ligament) and not a bone fracture. Also remember that some severe sprains need to be resolved with surgery. Basically you have to let the final diagnosis and treatment be established by a licensed orthopedist.
Step 2. Allow the doctor to see you
In addition to asking questions about the symptoms described in the first part of this article, the orthopedist will physically check the finger. It could test the strength and range of motion of the thumb by comparing it to the healthy one. Another test involves touching the tip of the thumb with the index finger before applying pressure to assess weakness.
Step 3. Get an X-ray
Your doctor most likely may request a series of thumb x-rays from different angles. With this exam, you will not only confirm the diagnosis, but will also be able to determine how many fractures there are and what treatment is best for you. The different radiological projections for the thumb are generally as follows.
- Lateral: the hand should be placed on the outer side, so that the thumb is pointing upwards.
- Oblique: in this case the hand is always resting on the external side with the thumb upwards, but it is also inclined.
- Antero-posterior (AP): this projection is obtained by placing the palm of the hand on the plane, so that the X-ray is "taken" from above.
Step 4. Ask the orthopedist if a computed tomography (CT) scan is worthwhile
This diagnostic imaging method uses X-rays and a computer processes the results to provide a digital image of the internal parts of the body (in this case of the thumb). Thanks to the CT scan, the doctor can get a better idea of how to repair the damage.
Remember to tell your doctor if you are pregnant, as computed tomography could harm the baby
Step 5. Let the doctor come to a diagnosis of the type of fracture
Once your orthopedist has done all the major tests, they can determine the exact type of fracture you have suffered. It will also have a complete picture of the complexity of the treatments available.
- Extra-articular fractures are those that do not involve the joint and affect the length of one of the two bones of the thumb. Although they are painful and take six weeks to heal, they usually don't need to be reduced with surgery.
- Intra-articular ones, on the other hand, are located on the joint and often have to be repaired in the operating room so that the patient regains the best possible mobility at the end of convalescence.
- Among the intra-articular fractures of the thumb, the two most frequent are the Bennet fracture and the Rolando fracture. In both cases the break occurs along the metacarpal joint (the one closest to the hand) and the bones are often dislocated. The main difference between the two is that Rolando's involves three or more bone fragments that need to be realigned, while Bennet's rarely needs a surgical solution. A Rolando fracture almost always needs to be reduced in the operating room.
Part 3 of 3: Treating a Fractured Thumb
Step 1. Get examined by an orthopedist who specializes in hand surgery
He will look at the x-rays to understand which treatment is most suitable. It will take into account the type of fracture (intra-articular or extra-articular) and its complexity (Rolando's or Bennet's fracture).
Step 2. Learn about non-surgical options
In relatively simple cases (such as an extra-articular fracture) the orthopedist is able to align the bone fragments manually without opening the tissues. Know that he will give you a local anesthetic before proceeding with the reduction maneuvers.
- This method (sometimes called closed reduction) involves manipulating broken bones guided by a fluoroscope (a machine that continuously emits X-rays to obtain moving images), which in turn allows the doctor to see the fragments as they are realigned.
- Be aware that in some Rolando fractures, especially those in which the bones have splintered into fragments too numerous to be fixed with pins and nails, the surgeon may also proceed with this method to reshape the various pieces to the best of his ability.
Step 3. Consider surgical solutions
When dealing with an intra-articular fracture (such as that of Bennet or Rolando), the orthopedist usually recommends surgery. The exact procedure depends on the type and complexity of the injury:
- Using the fluoroscope, metal wires are inserted into the skin to realign the bone fragments. This solution applies with Bennet's fractures, when the fragments remain close together.
- The surgeon opens the tissues of the hand and fixes the bones with screws and pins to realign them in the right way.
- Complications from surgery can be ligament and nerve damage, stiffness, and an increased risk of arthritis.
Step 4. Immobilize the thumb
Regardless of whether or not you need to undergo surgery, the orthopedist will wrap your finger in a cast or splint to immobilize it and lock all fragments in the correct position during healing.
- You will need to wear the cast or splint for between two and six weeks; in most cases the orthopedist will recommend a time close to six weeks.
- During your recovery, your doctor will want to see you several times for check-ups.
Step 5. See a physical therapist
Once the cast is removed, depending on the residual mobility of the thumb and the length of the immobilization period, the orthopedist may recommend that you see a physical or occupational therapist. Both of you will undergo a series of flexion and thumb grip exercises to strengthen the atrophied muscles from the period of inactivity.
Advice
Regardless of whether your thumb is sprained or broken, you should always go to the emergency room for proper care
Warnings
- While this article offers some medical information about a thumb fracture, it is not professional advice. Always go to a doctor to get a formal diagnosis and treatment for any potential serious injury.
- If you are pregnant, tell your doctor before you have x-rays. Fetuses are very sensitive to X-rays and it is best to avoid this diagnostic method to tell if the thumb is fractured.
