How broken knuckles are treated will depend on a variety of factors, including the nature of the break, the age and occupation of the patient, and the level of function that is needed in the hand.
The most common type of treatment is known as “neighbor strapping.” As you might suspect, this treatment involves strapping, or taping, the finger with the broken knuckle to the one next to it. Once trapped, the strapping is kept in place for approximately three weeks. If strapping is impractical, then often a splint or plaster cast will be used, and again, it is left in place for usually about three weeks. If these treatments fail, or if the break is complex, surgery may be needed.
Types of Surgery
Various types of surgery can be considered for broken knuckles. One of the most common types of surgery involves the installation of thin metal rods, known as Kirschner wires, or K-wires. They are placed across the broken bones, in order to hold them in place until they heal (usually within three weeks). A bit of wire is left exposed outside the skin, and when the healing is complete, the wires are simply removed using a special type of pliers.
Interosseous wires are another way of holding the broken bones together. This type of wire is often permanently left in place.
Plate fixation involves the use of small plates made of metal, attached to the broken bones by means of small screws. They are also left permanently in the hand. This type of treatment is usually for metacarpal breaks in the palm area, rather than in the knuckles themselves.
Complex breaks may need external fixation. With this type of surgery, a thick pin is inserted through the skin and into the bone on both sides of the break. Then, a metal bar is placed between the pins in order to keep the bones still and any bone fragments in place while healing takes place.
Complications can occur with broken knuckles. The most common complication is stiffness. The break, along with the splinting needed to correct it, can often result in the affected finger not having the same flexibility of movement as it did before the break. Often, physiotherapy can help with stiffness, but in many cases a return to full functionality is not possible.
Pain can also be a complication. Usually it will not be severe, but patients often notice that the affected area aches during cold weather, or when heavy work is being performed.
Occasionally, there are problems with the healing process. Delayed union occurs when the break does not heal as quickly as it should. This is an inconvenience, but the bone will heal properly eventually. More problematic is non-union, which is when the bones fail to heal even after several weeks. When this happens, further procedures will be required. Mal-union is a condition where the bones heal in a bad position. This could be a non-issue, but if the function of the hand is affected, it may be necessary to perform further treatments on the knuckle.
Finally, as is the case with any type of surgery, there is a slight possibility of infection. When bone is infected, this is known as osteomyelitis. Sometimes a course of antibiotics, or additional surgery, can cure the infection. Sometimes, though, it will not clear. The worst case scenario is that the finger may need to be amputated.