OT: Surgery or let it heal on its own?

[buckfifty]

Hi guys, I was wondering if I could hear your opinions on this. I recently had a crash on the bike and the only injury I luckily sustained was a break in my fingertip (distal phalanx for you docs out there). I got it checked out by an orthopedic doctor today, there's a small step off in the break where the broken off part of the bone doesn't exactly line up with the main part. The options given to me were splint it and wait til it heals or surgery where a wire would be placed to line up pieces.
Problem is that the doctor didn't exactly tell me which one would be better for me. He said that since I'm relatively young (29), it would probably heal correctly on its own. But maybe I may lose range of motion in the finger (the ring finger).
Anyone else experience something similar and what did you do?
Thanks

[93legendti]

When I hurt my knee and partially tore my ACL, I saw 3 doctors and I went with the one who I trusted and sounded the most reasonable.

One said operate and repair my "torn ACL". The other said rest. The third said, I don't know what's wrong, but your knee is locked and I need to get inside and see why.
I went with the last dr. A bone chip was in my joint and he found that my ACL was partially torn, but I had good stability. That was 25 years ago haven't had to replace/repair the ACL yet.

Get another opinion or 2.

[Richard]

93legendti's advice is the best you can get. Just don't get the additional opinions from the internet.

[Fishbike]

My husband had something similar with a finger -- but problem was with a ligament, not a bone. One doctor strongly advocated surgery. Another advocated "wait and see" for 8 weeks with a splint. After 8 weeks in the splint, the finger was fine. He was glad he did not jump into surgery.

But you have a different situation and need at least one other opinion. One key question is if you wait and see and finger does not heal well, is surgery still an option? Does surgery become more difficult after the bone heals?

Best wishes.

[bobswire]

I've had two broken wrists, one fractured elbow and one broken little finger.
Never had surgery or pins/screws to set them, almost all healed on their own except for one,the finger. Doctor Had to re-break it then reset it, that was fun.

[alessandro]

What 93legend said. Find a doc who you trust and who gives you complete information, and takes the time to answer your questions fully. If the orthopod you saw couldn't tell which option would be better, find one who will at least explain both options more thoroughly.

Also, how much loss of range of motion? Which way--flexion (fist) or extension (flat hand)?

[bargainguy]

Two things to consider:

1. If you decide not to have surgery, best to really limit activity with that hand until it heals so as not to disturb alignment. In other words, take it easy.

2. If at some point you decide to have surgery, make sure it's an orthopod with specialty in hand surgery, or even a plastic surgeon with same. Just me, but I wouldn't want a general orthopod who hasn't done a bunch of these hand operations before doing mine.

[buckfifty]

Probably flexion. Thanks for the advice, I'm going to find another doctor to take another look at it

[thwart]

Sounds like what's known as a 'mallet finger'.

If folks can manage it with 'an active lifestyle', full-time splinting is usually the initial treatment of choice. Some do wind up with a loss of full extension (being able to completely straighten out that last joint in the finger). If splinting fails, one can always go to Plan B: internal fixation with a pin, wire or screw.

Just don't get the additional opinions from the internet.

Good advice there.

[John H.]

Want it to look like this?
I broke this one about 15 years ago-
Works fine- looks terrible.
If I had it to do all over again I would get it fixed so it straightens.

[gasman]

He doesn't have mallet finger which is a rupture of the extensor tendon of the distal interphalangel joint. He has a fracture of distal phalanx with a step off. Splinting a mallet finger often works well- I had one several years ago. I'd say you should go see a busy (experienced) hand surgeon and get their opinion and discuss the options with you more fully.

[cderalow]

I broke my left clavicle (collar bone) in a non-cycling related incident several years ago.

I saw 3 different orthopedic doctors and all three had different opinions.

1st was using a cross brace to help keep me in position to let it heal naturally after reviewing an x-ray. (one large sneeze later and the excruciating pain told me that was the wrong solution)

2nd was using a standard sling and wait for it to heal after reviewing 3-4 x-rays (including several taken at the ER from initial accident and from doc #1). a week later with still constant pain and feeling it move sent me to #3

3rd took 3-4 x-rays, reviewed all of the xrays from the above two and ER then had me get an MRI done. He opted for Surgery and a week later i was proud owner of a titanium plate and 10 screws.

granted the 3rd guy had two weeks of 'healing' and x-rays to compare the original ER xrays to, but after the MRI it clearly was never going to heal on its own as the 'x-ray shadows' the 1st & 2nd guys saw were pieces of my splintered bone 90° to the direction they were supposed to be . It took him and another guy 6 hours to fix it.

I'll say this though... its never been the same, and I get sporadic pain from nerves and scar tissue snagging on the edge of my plate and I've had 2 screws reset into the bone.

[cash05458]

I broke my finger last year...one right next to my bird finger...it is crooked, much in the way of the photo above...but not quite as bad...after a few months of it hurting I went to my doctor...she said this: " I am sure we can find lots of people who might want to poke around in there...which might do more damage, or it might straighten it out abit...my advice is if it stops hurting (which it did a month later) then to just consider it your lucky finger..."

I took that advice and finger is fine...lil crooked...but fine...

[shovelhd]

I broke the knuckle in my fingertip in a race crash this season. I could bend the tip of my finger back 90 degrees right after the wreck. I went to rapid care who confirmed the break, and splinted it. I saw my orthopedist a few days later, he reset it and splinted it again. I wore the splint for about 6 weeks. I was able to ride after about 4 weeks. It was too painful to pull the brakes up until that point. It has healed almost completely now, 4 months later. I still have a little bit of pain when I use the full force of the finger on the joint.

Best of luck to you.

[evo111@comcast.net]

A few other questions to ask are which hand is it your dominant or non dominant hand (will it interfere with your ability to write) and what kind of work or hobbies do you do (Concert pianist, guitar player, etc.) Tasks requiring fine motor skill/dexterity maybe less tolerant of misalignment.

That being said I broke my little finger years ago splinted myself its a little crooked but works well.

[wc1934]

I'd say you should go see a busy (experienced) hand surgeon and get their opinion and discuss the options with you more fully.

The above - get a second opinion, and if you need surgery go to a doc who has performed tons of these types of procedures - a doc who can do these in his sleep.

[FlashUNC]

What everyone else said. My situation was a bit more dire and surgery was a must.

But find someone who's done a lot of these if you are going the surgery route.

[buckfifty]

it's on my right hand, my dominant one. so when he said I may lose some range of motion, i was kinda concerned cause i like how my fingers moved before and wouldn't want any hindrance to it.
side note: I talked to my mom about the visit and she actually visited the same doctor for her hand surgery. She also had problems with this particular doctor concerning communication (he also never really gave me a confident answer on whether opting for the surgery would be best) and he seems like he was in a rush (it was a busy office). So i feel assured to take this matter to a different doctor and see what he has to say

[evo111@comcast.net]

Find another hand surgeon (they can be an orthopedic surgeon or plastic surgeon as long as they did a hand fellowship) Find someone who takes time to speak with you and you get the right vibes from. You are the customer and need to be happy/satisfied about the care/relationship you have.

[gasman]

find another hand surgeon (they can be an orthopedic surgeon or plastic surgeon as long as they did a hand fellowship) find someone who takes time to speak with you and you get the right vibes from. You are the customer and need to be happy/satisfied about the care/relationship you have.


this ^^^^

[thwart]

He doesn't have mallet finger which is a rupture of the extensor tendon of the distal interphalangel joint. He has a fracture of distal phalanx with a step off. Splinting a mallet finger often works well- I had one several years ago. I'd say you should go see a busy (experienced) hand surgeon and get their opinion and discuss the options with you more fully.You can have a bony fragment pulled off by that extensor tendon, therefore an avulsion fracture. Treated the same way (unless it's a big chunk, IIRC). But, yes, I re-read the OP's description, and it does sound like an actual fracture of the distal phalanx.

You had good luck with your mallet finger, unfortunately quite a few wind up looking like John H's.

[shovelhd]

You can have a bony fragment pulled off by that extensor tendon, therefore an avulsion fracture.

Just what happened to me. Big chunk missing.

[pitonpat]

Working in construction all my life, I've had a few hand injuries. Broke my index finger once. On the job it seemed like a simple break of the middle bone in the finger. I cut a piece of steel banding from a lumber pile, bent it to a gentle curve, then taped it to the underside of my finger (a neanderthal splint!). Went back to work, wore it that way for a couple of weeks, and all's good after many years. Never went to a doctor about it. Besides, a little deformity of the fingers seems to be expected for guys in the trades & it provides light comic relief when cradling a coffee cup on the job!

Seriously, if you're concerned get additional qualified opinions. After all, you don't want to lose fingertip dexterity- that makes typing on bike forums problematic.

[Tom]

If you do surgery, get to a hand therapist as soon as possible. I didn't go until this nice thing was removed and my little finger doesn't bend any more. I drop stuff a lot. The therapist was disappointed she didn't get at this while the wires were in. They did tell me I needed to bend it when the wires were in but it hurt a lot so I thought I was screwing it up. And yes, those are three wires through the bone with two nice double prongs for the rubber bands that had the added benefit of catching on everything possible and tugging on the whole rig when they did.

That finger was the point of contact when a driver right hooked me from a standing stop and I hit him going about 25. Bike computer went from 25 to 0 while I took a nap.