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My ring and baby fingers broke when they got slammed in a car door. After I wore a fiberglass cast for 4 weeks, they took it off yesterday. My hand was a gross mess but I guess that's typical from wearing a cast. It all washed off pretty well. What I don't understand is why it looks like my knuckle is missing (the big knuckle you normally see when making a fist). I am definitely not happy about how it looks.

You may have had a Boxer's fracture affecting the metacarpal (long) bone of the ring and/or little finger is the most common fracture of the metacarpal neck. As the name suggests, the "neck" is the area between the long shaft of the bone and the round knobby end (the "head") that helps form the joint. With a neck fracture, the metacarpal head can poke out into the palm of the hand or rotate causing a deformity. Typical treatment for Boxer's (metacarpal neck) fracture is just immobilization (nonoperative approach). If surgical fixation is needed, Kirschner wires are used. After surgery, the hand is placed in a cast or splint for up to a week followed by the use of a special metacarpal brace that allows use of the hand. Recovery can take a few months or more. The wires aren't removed for three months. Getting strength and motion back can take a bit longer. Patients who have had surgery for this type of fracture report they do not like the looks of the scar. Patients who have not had surgery often say they do not like the appearance of the hand (the fifth knuckle disappears without surgical repair). This is what you are noticing, too. If you are bothered enough about how it looks, you can have additional surgery to correct the appearance. If your function is not impaired (grip strength, use of the hand and fingers), then you do not need a second surgery except for cosmetic reasons. Your final decision may be determined by whether or not your insurance would cover the cost of another surgical procedure when it is considered "elective" (not required).

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