Is splinting or extension block pinning best for my little finger injury on my right hand?

Hello,

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I understand that the decision can be daunting as there are only statistics to play with, but it has no relevance to an individual case. With your fracture, the main issue is we can get the fracture to reduce in the splint, and though 60 % do well straight away, another 20 % may become satisfied at up to six months or more with minimal lag in extension. The joint may function satisfactorily without arthritis. It is all to do about compliance with the splint, confirmation of maintenance of position with repeated x-rays, and the possibility of needing surgery hanging till about six weeks. Extension block pinning has been recommended for fractures with large intraarticular fragments such as yours over 50 percent, as it may lead to subluxation even in a splint. In addition, surgery can be done in local anesthetic so that general anesthesia can be avoided and done as a daycare process. Disadvantages are surgery, pins sticking out for six weeks and a minor procedure for removal of wires, the possibility of infection, inability to use the finger during this time, and the need for night splints even after the wires are removed for another four to six weeks. Surgical expertise is the most important factor here. Your current age is not a factor that affects fracture healing, I hope I have answered your questions. Now the decision is yours.

Hello,

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1. The finger will need protection while you have the wires as the wires can get snagged, and you may poke someone or even yourself through the wires. Hence it is full-time wear. After the removal, you will need a regular splint for full-time use.
2. No percentage can be given as it depends on your hospital rates and how much you manage to look after the finger hygiene, mainly less than one to two percent.
3. Pain will be there only if you knock it.
4. Closed pinning can be done in a matter of two weeks or longer if the fracture can be reduced in a closed method. The open procedure can be done at any time.
5. By using K wires, there will be a big covering protection line on the inside of a wicket-keeper glove, and splints are less obstructive.
6. As I alluded to earlier, if the conservative splint option succeeds, then 80 percent chance of complete movements and good function.
7. Infection usually happens at the time of surgery and is less likely. However, it is possible if the pins get loose or with an open surgery wound if hygiene is not maintained.
8. Pin site care is to be maintained till the pins are in place.
9. You may need surgery with open techniques.
10. The doctor soon makes a decision that you need a splint, which needs to be monitored for a position with repeated X-rays.
11. The wound heals well with pins.
12. There is the issue with changing the course mid-way.

Hello,

Welcome back to icliniq.com.

I will answer your questions by asking you to remember the injury to the middle finger, which is very similar to the current damage to the little finger. You may not realize it, but you already had the recent injury in the middle finger some time back. I disagree with the radiologist saying that the joint is stable and aligned. I feel the articular surface of the fragment attached to the bone is not congruent with the head. Instead, it seems subluxated to me. I still think you need a surgeon to reassess what I have mentioned and consideration for pinning the fracture has to be put on the table now. If we pin, this is likely to be an open procedure, and healing will start afresh. If we successfully reduce it in a closed way soon, it may be better, but the pin should stay for four to six weeks.

Hello,

Welcome back to icliniq.com.

I cannot foresee the future, but the question is, are you satisfied with the middle finger function and looks? (I see it has a lag and does not flex fully). The subluxation can worsen in the splint if too much pressure is applied, and it may slip further with time. The result of movement will depend on the degree of subluxation as I cannot predict that. I would rather reduce the fracture and pin it. At the current position, if we can make it stay there and prevent it from getting worse, you may have some loss of function, perhaps similar to a middle finger. The little finger needs to bend more for a good grip.