What healing process and timeline can I expect following crush injury to fingers?

March 17, 2008 10:49 AM

What healing process and timeline can I expect following crush injury to fingers?

50 year old man, good health. About 6 weeks ago the fingertips of my index and middle finger (left hand) were crushed in an accident. Broken distal phalanges and some surgery to repair one nail bed. Stitches to repair fingertip lacerations. Still in splints today, I was disappointed at the 4 week checkup to see, via some real-time x-ray, that the fingertip bones were not fused together yet. Hoping at next appointment, at 8 week mark, to see improvement.

While I am extremely grateful to not have lost my fingertips, I am very anxious about this since I am a performing musician and wonder if/when I will regain my ability to play.

Any insights on healing process from similar experienced would be most appreciated.

posted by LeeNicholson to health (9 comments total)

some recent work from Japan I think (I'll try to dig it up), suggests 40% non-union in tuft fractures, which is where I'm guessing your problem was from the description?

Splinting is the treatment of choice for tuft fractures even open ones.

Have your surgeons referred you to a physio or re-hab specialist and are they aware that you are a musician? (sorry for the Doh type questions but you'd be surprised)
posted by Wilder at 11:06 AM on March 17

This is a good resource of info and this is the Japanese paper I cited.
posted by Wilder at 11:10 AM on March 17

Sorry, having posting difficulties at the mo
Resource
Japanese study
posted by Wilder at 11:15 AM on March 17

Wilder, thanks very much for the quick reply. The phrase "tuft fracture" is new to me. The weight of the blow came across my fingernail and the bones underneath were fractured - almost straight across from what I saw on the x-ray.

Good question. I believe I am in queue to see a hand therapist once the healing takes place. I will double check at next follow up with surgeon. Yes, I made it clear to everyone along the way (EMT, ER, surgeon) that I am a musician - I think this is what got me the referral to a hand surgeon specialist.
posted by LeeNicholson at 11:19 AM on March 17

The obligatory IANAD declaration (To be clear, I am a medical educationalist NOT a surgeon, although my job is to check on the training of junior surgeons)

Hand surgeons here in the UK are either Plastic or Trauma & Orthopeadic surgeons, old-fashioned delineations which obscure how much they have in common. I know quite a few hand specialists.

You need to talk to a hand surgeon sooner rather than later, see this.

Stable movement is critical to ensuring long-term flexibility and avoiding adhesions. But only a surgeon can tell you what, in your particular case, that means.
posted by Wilder at 12:50 PM on March 17

Also, from your concern, would I be correct in assuming a string(ed) instrument?
posted by Wilder at 12:59 PM on March 17

Thanks again, Wilder. I have been to a hand surgeon who repaired the nailbed under my index fingernail He splinted the fingers with these sort-of plastic thimble-type splits that protect the fleshy part of the fingertip and make bending the DIP joint (is that the tip joint?) almost impossible. I can bend at the second knuckle and, on one hand, I have heard it is good to do that to retain flexibility but, on the other hand, I have heard that might put stress on the tendon to the distal phalanx and might disturb the healing process of the bone. Ugh!

The break was straight across the distal phalanx in each finger. Like you might grab a pencil and split it in two.

Yes, stringed instruments. I have been a folk musician in the USA for decades: guitar, fiddle, mandolin and banjo.

I appreciate your input!
posted by LeeNicholson at 5:19 PM on March 17

LeeNicholson, you definitely need to hear this from the horse's mouth. Those X-rays should be reviewed by your surgeon and you should only do the excercises he/she prescribes.

Don't listen to anything else, as you can see, you will find a multitude of different approaches. I got the impression you just hadn't had a chance to ask these questions in the consultation and I don't really know how the US system works as it is very different from the UK.
If this were my hand, I would ring the surgeons' secretary, give her a unit number so she could pull the x-rays and put them in his/her e-mail box, express my real concern as a musician about the non-union and ask him to review the results and advise on the safest way of mobilising the joints in question. I'd ask to be copied into his/her correspondance with the physio and my GP.
In Belgium where I've udergone surgery I e-mail the surgeon directly and usually I get a reply within a day or two.
I don't know what will work for you but you really need to have a hand surgeon advise you on this.

best of luck!
posted by Wilder at 10:13 AM on March 18

Update: bones are healed. Splints are off - this is good! Now to work on regaining range-of-motion. 8 weeks of immobilization due to splinting has left me unable to make a fist, let alone play a musical instrument. Why is this? Swelling... sediment in the joints...?
posted by LeeNicholson at 12:02 PM on March 24