Management of Index Finger Injuries
The management of index finger injuries requires a combination of radiographic evaluation and appropriate treatment based on injury type, with functional splinting being preferred over complete immobilization for stable, non-displaced fractures to promote early rehabilitation and better outcomes. 1
Initial Assessment and Imaging
Radiographic Evaluation
- Essential views for proper assessment:
- Posteroanterior (PA) view
- Lateral view
- Oblique (45° semipronated) view 1
Advanced Imaging When Indicated
- CT scanning: For complex fractures with intra-articular extension or preoperative planning
- Ultrasound: Preferred for detecting superficial foreign bodies and assessing surrounding structures
- MRI: Recommended when clinical suspicion remains high despite normal radiographs, particularly for ligamentous injuries 1
Treatment Algorithm Based on Injury Type
1. Stable, Non-Displaced Fractures
- Preferred approach: Functional splinting over complete immobilization
- Rehabilitation protocol:
- Early active finger movement exercises
- Supervised exercises focusing on proprioception, strength, and coordination
- Progressive return to function 1
2. Unstable Fractures
Key indicators of instability:
- Palmar displacement of the distal phalanx
- Interfragmentary space >3mm
- "Mallet" bone lesions involving >1/3 of articular surface 1
Management approach: Surgical intervention indicated
- Options include open reduction and internal fixation
- Arthroscopy-assisted reduction for complex cases 1
3. Intra-articular Fractures
- Surgical indications:
- Step-off >2mm
- Coronal orientation fractures
- Die-punch depression
- Multiple articular fragments 1
4. Soft Tissue Injuries
Conservative management: Appropriate for most sprains and minor avulsions
- Splinting and occupational therapy 2
Surgical referral required for:
- Mallet finger deformities
- Profundus tendon avulsions
- Open extensor-mechanism injuries
- Complete collateral ligament ruptures at PIP joint 2
Special Considerations for Proximal Interphalangeal (PIP) Joint Injuries
Hyperextension Trauma
Acute phase management:
- Careful assessment for volar plate rupture through history, physical exam, and radiography
- Conservative treatment with appropriate splinting for minor injuries
- Surgical intervention for significant volar plate ruptures 3
Prevention of complications:
- Intensive physiotherapy during follow-up is essential
- Early intervention to prevent chronic post-traumatic hyperextension deformity and flexion contracture 3
Potential Complications and Prevention
Common Complications
- Malunion
- Non-union
- Avascular necrosis
- Carpal instability
- Complex regional pain syndrome
- Osteoarthritic changes 1
Prevention Strategies
- Prompt treatment: Delays can lead to vascular compromise and long-term functional impairment
- Osteoporosis screening: Recommended for patients over 50 years with wrist fractures
- Systematic fracture risk assessment: Important for preventing subsequent fractures 1
Follow-up Care
- Regular assessment of healing and function
- Adjustment of treatment plan based on progress
- Referral to hand therapy for complex or slow-healing injuries
The management of index finger injuries requires careful assessment and appropriate treatment to minimize long-term disability. Most injuries can be managed conservatively with proper splinting and rehabilitation, but certain injuries require prompt surgical referral to ensure optimal outcomes 4, 5.