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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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My husband slammed his fingers in the car door. He broke the ring and little fingers. Three hand surgeons are meeting right now to figure out what to do. I guess the baby finger has a piece of bone pulled away from the main finger bone. There's a ligament still attached and that's what they are studying. Why is this such a big fuss?

Fractures of the fingers can be a complex surgical challenge -- especially if it's an avulsion fracture. Avulsion means the bone has broken off with a piece of soft tissue still attached. There could be a slip of tendon, ligament, or volar plate still connected to the bone fragment. Reattaching the tiny bone fragment requires special surgical tools and techniques. As you can imagine they don't even make screws tiny enough for some of the smaller pieces of bone that avulse. And the force of putting a screw through the bone fragment can be enough to cause another fracture (or even break the bone fragment into a number of smaller pieces). To avoid such complications, a special hook plate has been designed. The hook plate is made of titanium. It is used when the avulsion fracture fragment is unstable and displaced (separated from the main bone). Joint instability and loss of finger function cannot be treated without this type of fixation. Conventional fixation devices such as regular-sized bone screws, wires, plates or tension bands can't be used to secure a stable fixation in these small avulsion fractures. This technique with the plate hook applies tension to the fracture site as well as acts as a buttress. The head of the screw is flush with the bone, so there's nothing sticking outside the skin. Inside the finger, the tiny hooks on the plate bite into the soft tissue where it inserts into the bone. The effect is to draw the pieces of bone back together. The surgeon must be careful to avoid creating a hinge as the fracture site. Infection at the surgical site is always a concern. Adhesions and scarring must be avoided with early movement and hand therapy. A splint may be used to hold the affected finger as straight as possible. The splint is usually taken off once every hour during the day to move the finger. Nothing about treatment for avulsion fractures of the fingers is quick and easy. Careful attention must be paid to the type of surgery, type of fixation, possibility of complications, and follow-up postoperative care. With three surgeons consulting on this one, your husband should be in good hands!


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