From the Guidelines
Suspect a fractured fifth metacarpal (pinky finger) when there is significant pain, swelling, bruising, or deformity following trauma to the finger, and radiographs of the area of interest are usually appropriate for the initial imaging of adults with acute blunt or penetrating trauma to the hand or wrist. According to the American College of Radiology 1, direct signs of a fracture include inability to move the finger normally, tenderness when touching the affected area, and visible misalignment. If you experience a popping or cracking sound at the time of injury, this further suggests a fracture. Pinky fractures commonly occur from falls, sports injuries, crushing injuries, or direct impacts.
Initial Assessment
- Significant pain or swelling in the pinky finger
- Deformity or visible misalignment of the finger
- Inability to move the finger normally
- Tenderness when touching the affected area
- A popping or cracking sound at the time of injury
Initial Management
- Apply ice to reduce swelling (15 minutes on, 15 minutes off)
- Immobilize the finger by buddy-taping it to the adjacent ring finger using medical tape with gauze between the fingers
- Elevate the hand above heart level
- Take over-the-counter pain medications like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed for pain
Seeking Medical Attention
Seek medical attention promptly, as proper diagnosis requires X-rays, and untreated fractures can lead to chronic pain, decreased range of motion, or permanent deformity, as suggested by the guidelines for acute hand and wrist trauma 1. Even seemingly minor finger injuries warrant evaluation if pain and swelling persist beyond a few days.
From the Research
Clinical Presentation
- A fractured fifth metacarpal (pinky finger) should be suspected in cases where the patient demonstrates hallmark clinical signs and symptoms, such as pain, decreased sensation, and intra-compartmental swelling 2.
- Patients with a history of trauma, such as a crush injury, should be evaluated for potential fractures or compartment syndrome 2.
- Mallet finger injuries, which can occur in any finger, including the pinky finger, typically present with a fingertip deformity and an inability to extend the distal phalanx actively 3.
Diagnostic Considerations
- Radiographs should be obtained to confirm the diagnosis of a fracture and to evaluate the extent of the injury 2, 3.
- A thorough neurovascular examination should be performed to assess for any compromise to the affected finger 2.
Treatment Options
- Conservative management with buddy taping and immediate mobilisation may be suitable for base fractures of the fifth proximal phalanx 4.
- Surgical intervention, such as open reduction and internal fixation, may be necessary for more complex fractures or those with significant displacement 3.
- Prophylactic antibiotics should be administered to patients with open fractures as soon as possible to minimize the risk of developing a fracture-related infection 5.
- Nonsteroidal anti-inflammatory drugs, such as ibuprofen, may be used for pain management, but their effects on bone healing should be considered 6.