Houston Methodist. Leading Medicine

Hand FAQ

Question:

I admit I had a little bit too much to drink last night. I woke up this morning in the hospital with a weird little contraption around my pinkie finger. Looks like some kind of metal cage. And the other hand is in a splint the nurse told me is a "clam-digger." It's Sunday and no one around to explain what the heck is going on. I've got a candy striper sending you this question. Hope you can respond while she is still here

Answer:

It sounds like you may have some broken (fractured) fingers (metacarpal bones) but of course, you will have to wait for the attending physician to give you exact diagnosis and full details. Fractures of the metacarpals can affect the head, neck, or shaft of the bone. The type of splint you are wearing (clam-digger) puts the wrist in a slightly extended (cocked up) position. This splint also holds the metacarpophalangeal (MCP) joints (big knuckles of the hand) in 90-degrees of flexion (bent). The rest of the fingers are straight. The clam-digger splint is usually used for metacarpal shaft (long portion of the finger bone) fractures. Fractures of the metacarpals usually only require casting and immobilization for a short time to promote healing. But if the fracture is separated (called displacement), unstable, or incongruent (broken ends don't line up correctly), then surgical fixation may be required. Fixation refers to the use of wires, plates, or screws to hold broken bones together until healing takes place. The surgery may be done as an open or closed reduction and fixation. The goal is to restore normal bone alignment and joint function. Specific approaches depend on the location and severity of the fracture. Your description of a cage around the outside of the finger suggests a surgical method referred to as external fixation. External fixation (hardware is inserted through the skin and bone but located outside the finger). These devices are miniature in size and custom made. The advantage of this type of fixation is early motion while the fracture is still healing. The use of external fixation for the little finger suggests the possibility of a Boxer's fracture. This type of fracture affects the metacarpal bone of the little finger. It 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. That's why it is carefully reduced (put back in its anatomic position) and held in place with hardware. The full mystery of what happened to you might not be revealed. But you should be able to at least find out what type of injuries you have, what's been done so far to treat them, and what to expect next. Peter C. Rhee, et al. Update on the Treatment of Metacarpal Fractures. In Current Orthopaedic Practice. July/August 2012. Vol. 23. No. 4. Pp. 289-295.

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