Thumb Sprain / Finger Fracture

Management of Thumb Fracture and Sprain: Important points to determine a broken thumb.

 

Thumb Fractures

The thumb or “pollux” comprises of two bones, anatomically termed as the phalanges. The bone which connects the phalanges to the wrist bones is known as the first metacarpal. Any of these 3 bones can be injured, thereby leading to a fracture. However, the first metacarpal is the most commonly fractured bone when it comes to thumb fractures. Thumb bones can be broken due to a multitude of reasons but the following ones are the most important:

1.    Forceful twisting of the thumb joints

2.    Falling on your hands resulting in trauma

3.    Stretching the thumb back too far

4.    Poor bone health i.e. diminished calcium levels in the body

5.    Any underlying bone pathology

People who are engaged in contact sports or sports that use some kind of handheld equipment are more prone to sustain these kinds of injuries. Wrestlers, football and hockey players, and skiers are at a higher risk for such fractures. Following are a few symptoms of a thumb fracture:

1.    Swelling and redness in the affected thumb

2.    Joint weakness

3.    Pain and tenderness

4.    Restricted mobility

5.    Apparent deformity of thumb anatomy

6.    Inability to grasp objects

7.    Tingling and numbness in the hands

8.    Cold feeling in the thumb due to a disrupted blood supply

 

Treatment

1. First aid: If you ever suspect that you might have fractured your thumb then put it under running cold water or apply ice bags to the swollen area immediately. Immobilizing the thumb along with the application of external splinting can help prevent any extensive damage. Also, keep the hand elevated to prevent blood loss and to reduce the thumb swelling as well.

 

2. Closed reduction with spica cast: Upon examination, if the consultant tells you that the bones are not that far out of place then he might be able to set the bones without having to go for surgery. This method is known as a closed reduction. It may be slightly painful for the patient, so they mostly inject local anesthetics at the site of maximum inflammation to smoothen the whole procedure. In the next step, a special cast is applied for bone reduction, commonly known as a thumb spica cast. This is usually kept in place for a total of 6 weeks and it holds the thumb while the fractured bone heals. It keeps the thumb tight in its place by covering it and the forearm, which ensures maximum healing efficacy.

 

3. Surgical Treatment: If there are a lot of scattered pieces of bone fragments, then it is impossible to treat the fracture via closed reduction. The patient will then require the expertise of an orthopedic surgeon.

A. If the first metacarpal is broken then this is called Bennett fracture and to treat this, a surgeon inserts wires and screws through the skin to hold the pieces tight in their position and ensure adequate bone healing.

B. In another scenario where there are multiple cracks at the base of the thumb, the surgeon usually inserts a small implant to hold the fragments together. This fracture is known as Ronaldo fracture and the treatment done is called open reduction with internal fixation.

C. The third method which may be adopted is called external fixation in which the surgeon will extend the metallic plate outside the skin.

 

Thumb Sprain

Thumb sprain usually occurs when the ligaments keeping the thumb in place are stretched beyond their limits eventually leading to their rupture. This happens when some massive force bends the thumb backward, away from the palmar surface of the hand. Most of the patients falling on the outstretched hands present with this complaint. The most commonly affected ligament is the ulnar collateral ligament (UCL). It disallows the thumb from undergoing dislocation and bending too far away.

A sprained thumb is also known as a skier’s thumb as the athletes participating in this sport often strike their thumbs with the skiing poles at high speeds. This might cause tears in the UCL. Another condition known as the gamekeeper’s thumb involves the avulsion of the ligament from its insertion point. This is a form of chronic sprain, it gets its name as it was originally called the Scottish gamekeepers (rabbit keepers) as these people commonly used their index fingers and thumbs to break the neck of a small game.

The movement of the thumb becomes quite unstable following a tear in this ligament and this may also weaken your ability to grasp objects. Following are the symptoms involved in this disease:

1.    Stiffness at the base of the thumb

2.    Pain and discomfort in the affected joints

3.    Limitation of movement

4.    Difficulty in pinching objects such as tying shoelaces

5.    Swelling and bruising around the thumb

 

Treatment

1. First Aid: The first and foremost action that the patient can take by himself is applying ice packs to the affected area. Refrain from excessive use of the thumb to prevent any further damage. Wrapping the area with a cloth can put pressure on the sprain and mitigate the throbbing pain. Elevation of the affected hand above the level of the heart is also needed to prevent high perfusion of the swollen area which in turn, helps reduce the extent of inflammation. After some settlement of the pain, it is necessary to visit the physician because leaving a sprain or minor fracture untreated can even result in permanent loss of function in the injured thumb.

 

2. Non-surgical treatment: To treat the minor sprain, the physicians will normally advise using a thumb spica splint. The splint is required to be worn by the patient until the ligament comes back to its original form. This usually takes around 6 weeks. In general, splints are applied to limit thumb mobility and provide mechanical support.

 

3. Surgical treatment: In case of severe and persistent pain, surgery is the only remedy for complete restoration of normal thumb anatomy. The procedure involves reconnecting the ligament to the bone or repairing the avulsion using special bone anchors or screws. After the surgery, the patient still has to wear the splint for the upcoming 6-12 weeks to protect the repaired ligament and to ensure complete healing of the joint.

 

How to differentiate between a thumb sprain and fracture?

The patient can easily differentiate between a thumb sprain and fracture by noting the degree of disability he faces. A sprain usually involves the ligaments and eventually settles on its own if proper care is taken. There isn’t any need for surgical intervention in most of the sprains as minor ligament tears gradually heal over time. But in thumb fractures, the deformity is visible in plain sight, and refusal of early treatment may lead to complications or even complete loss of function of the affected thumb. Therefore, the patient needs to take precautionary measures in each situation, and consulting a physician can significantly mitigate most of the problems further on.

 

How to prevent thumb sprains and fractures?

It is very difficult to eliminate any chance of causing sprained thumbs if the occupation of a person demands their repetitive utilization. But care can be taken to prevent any such mishap from occurring in the future. For that purpose, the following tips are recommended:

1.    Strengthen surrounding muscles of the arm: A regular exercise involving extensor and flexor muscles of the arm helps establish greater control over the wrist movement, and therefore, a person can easily sustain a more intense shock from activities such as contact sports and skiing.

2.    Avoiding activities that tend to over-extend the thumb.

3.    Maintaining a healthy diet replete with proteins and vitamin D.

4.    A regular intake of dairy products to provide the body with sufficient calcium to support adequate bone health.

5.    Thumb exercises should be repeated daily to provide conditioning and rehabilitation for the recovering fractured or sprained thumb.