From the Guidelines
Closed reduction of a finger fracture should ideally be attempted as soon as possible after injury, preferably within the first few hours and generally within 7-10 days. The optimal timing is within 24-48 hours when swelling has begun to subside but before healing has progressed to a point where reduction becomes difficult 1. Prior to reduction, appropriate analgesia should be administered, typically a digital nerve block using 1-2% lidocaine without epinephrine (1-2 ml per side). X-rays should be obtained before and after reduction to confirm alignment. Early reduction is preferred because as time passes, soft tissue contractures develop and bone healing begins, making reduction more difficult and potentially less successful. Additionally, prolonged displacement can lead to stiffness, malunion, and long-term functional impairment.
Some key points to consider when attempting closed reduction of a finger fracture include:
- Early finger motion is essential to prevent oedema and stiffness, and should be started as soon as possible after injury 1
- Immobilization should be discontinued as soon as possible, and aggressive finger and hand motion should be encouraged to facilitate the best possible outcomes
- Elevation and ice for 24-48 hours before reduction may improve outcomes if significant swelling is present
- After reduction, proper immobilization with buddy taping or splinting is essential to maintain alignment while healing occurs, typically for 3-4 weeks depending on fracture location and stability.
It's also important to note that the timing of closed reduction may vary depending on the individual patient and the specific fracture, and that the decision to attempt closed reduction should be made on a case-by-case basis, taking into account the patient's overall health and medical history. However, in general, early reduction is preferred to minimize the risk of complications and improve outcomes.
From the Research
Timing of Closed Reduction for Finger Fractures
The optimal time to attempt closed reduction of a finger fracture is not strictly defined, but several studies provide insights into the management of such injuries.
- Closed reduction can be attempted as soon as possible after the injury, ideally within a few days 2.
- One study suggests that active and passive range-of-motion exercises can be started within 3 days after injury, implying that closed reduction, if necessary, should be done promptly to allow for early mobilization 2.
- Another study emphasizes the importance of evaluating the fracture's stability and the potential for rotational malposition or significant shortening before attempting closed reduction 3.
- The decision to attempt closed reduction should be made on a case-by-case basis, considering factors such as the fracture's location, geometry, and stability, as well as the patient's overall condition and potential for compliance with post-reduction care 4.
Considerations for Closed Reduction
When considering closed reduction for a finger fracture:
- The goal is to achieve and maintain an acceptable reduction to allow for proper healing and minimize the risk of complications such as malunion or stiffness 5, 4.
- Closed reduction may not always be successful, and the fracture may redisplace during the immobilization period 5.
- The method of reduction (e.g., manual manipulation vs. finger-trap traction) may not significantly impact the outcome, but the key is to achieve an accurate reduction and provide adequate immobilization 5.
- In some cases, surgical intervention may be necessary, especially if closed reduction is not possible or if the fracture is unstable 4, 6.
Post-Reduction Care
After attempting closed reduction:
- Immobilization should not exceed a month to prevent stiffness and promote recovery 3.
- Regular follow-up is crucial to monitor the fracture's healing progress and address any potential complications early on 2, 4.
- Rehabilitation, including range-of-motion exercises, is vital to regain finger function and strength 2, 4.