Is it contraindicated to suture a laceration on a finger with an underlying fracture?

Management of Lacerations with Underlying Finger Fractures

It is not contraindicated to suture a laceration on a finger with an underlying fracture, but immediate appropriate treatment including irrigation, debridement, fracture reduction, and antibiotic administration is essential to prevent infectious complications. 1

Risk Assessment and Initial Management

When dealing with a finger laceration with an underlying fracture:

1. Infection risk is significantly higher with delayed treatment

   • Studies show 45% infection rate when treatment is delayed beyond 24 hours versus 0% with appropriate immediate treatment 1
   • Open fractures with associated soft tissue injury require prompt intervention

2. Essential components of appropriate management:

   • Thorough wound irrigation with sterile normal saline 2
   • Removal of superficial debris
   • Fracture reduction if displaced
   • Antibiotic prophylaxis
   • Proper wound closure

Specific Considerations for Finger Lacerations with Fractures

Wound Closure Technique

• Primary closure is appropriate if:
  • Treatment is provided within 8 hours of injury
  • Thorough irrigation and debridement has been performed
  • Fracture has been properly reduced
  • Prophylactic antibiotics have been administered

Special Situations

• Seymour fractures (Salter-Harris I/II or juxta-epiphyseal fractures of the distal phalanx with associated nailbed laceration):
  • Require particularly urgent treatment
  • 0% infection rate with appropriate acute treatment vs. 45% with delayed treatment 1
  • Complete treatment includes irrigation, debridement, fracture reduction, and antibiotics

Antibiotic Considerations

• Short-course, single-agent regimens using cephalosporins are recommended for open fractures 2
• The Surgical Infection Society recommends against extended-spectrum antibiotic coverage for type I or II open extremity fractures 2
• For type III open fractures, antibiotic therapy should not exceed 24 hours after injury in the absence of active infection 2

Post-Procedure Care

• Elevation of the injured finger accelerates healing, especially if swollen 2
• Regular assessment of wound healing and radiographic union is necessary 3
• Early mobilization and directed exercises help prevent stiffness 3
• Monitor for complications such as:
  • Septic arthritis
  • Osteomyelitis
  • Subcutaneous abscess formation
  • Tendonitis
  • Nerve or tendon injury 2

Common Pitfalls to Avoid

1. Delayed treatment - The single most significant risk factor for infection in finger fractures with lacerations 1
2. Inadequate irrigation - Thorough cleaning is essential to prevent infection
3. Failure to recognize underlying fracture - Pain disproportionate to the severity of injury located near a bone should suggest periosteal penetration 2
4. Overlooking tetanus prophylaxis - Ensure tetanus status is current 2, 4
5. Excessive immobilization - Can lead to stiffness and poor functional outcomes 3

Conclusion

When managing a finger laceration with an underlying fracture, the evidence strongly supports that suturing is not contraindicated. However, the timing and quality of treatment significantly influence infection rates. Immediate and appropriate treatment including irrigation, debridement, fracture reduction, and antibiotic administration is essential to prevent infectious complications and achieve optimal functional outcomes.