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

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

Patient's Query

Hello doctor,

I am a 37-year-old male. Five days back, I got hit by a cricket ball on the small pinky finger on my right hand. I am attaching the X-ray image and report. Right now, I have a splint. What do you recommend for my case?

The doctor told me two options such as a splint or extension block pinning.

Now my questions are,

  1. Which option is recommended?
  2. If I go for a splint, what percentage of risk is there? I found on the internet that sometimes having a splint for a major fracture increases the risk of deformity, instability, and degenerative changes in the joint. Is there any of this possible for my injury level?
  3. 5 to10 % of deformity is fine for me since I need to take care of two kids daily. If surgery needs more resting time while adding or removing pins, I try to avoid it. If the splint will work 90% in my case, then I would prefer that.
  4. Is 37 age acceptable for bones to connect with just a splint?
  5. How many days does adding and removing pins require, and how many days heal time for surgery holes?
Answered by Dr. Atul Prakash

Hello,

Welcome to icliniq.com.

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.

Patient's Query

Hello doctor,

Thank you for the reply.

Please help with answers to all questions as that would help us to decide.

  1. Will the splint needs to be on day and night even after putting pins, or is it required after removing only?
  2. What is the percentage possibility of infection during the insert and removal of a pin?
  3. Will there be pain while the pins are inside?
  4. How many weeks from the injury can we do pins?
  5. What is the procedure for fixing after the pins option window if the split is not doing well?
  6. In terms of doing work which is better - pins or splint?
  7. I understand there would be a minimal deviation in bringing it straight. How about bending the finger? Will it go at least 80% with just a splint procedure?
  8. In case of pins infection, is that mainly because of letting water or not maintaining it properly after surgery?
  9. How many days do we need to avoid the water after inserting the pin and removing the pin?
  10. You mentioned subluxation with a splint. If that happens, it needs more splint time or surgery.
  11. If we choose to wait and watch mode with split, how long can we wait safely and start surgery? When should I be alarmed and see a doctor immediately?
  12. Will doing pins after a couple of weeks restart everything in terms of healing time, or initial settling of bone will still help?
  13. Whether splints reduce some motion in the finger, or it could need additional healing time?

There is nobody here to take care of the kids. That is the main reason behind all this confusion in me. Sorry for a lot of questions. Please help with each.

Answered by Dr. Atul Prakash

Hello,

Welcome back to icliniq.com.

  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.

Patient's Query

Hello doctor,

Thank you for the reply.

I took an X-ray today with a splint on just to see how that fragment aligns with the main piece with the splint on and the finger kept straight as this is the position I am going to maintain at least for a few weeks if I am not going for pinning. Few questions related to that,

  1. Does this look healing in the right alignment so I will not lose much movement (including bending) later, or does it seems not aligned well, and we should go for the pin option to align this?
  2. If we feel like this requires pinning and they adjust the fragment to reduce well, does that restart the healing process from pinning time as the doctor is available only four days from now?
  3. Is the small fragment facing slightly upwards that needs to bring down to align with the main bone using a pin, or is it a straight line only and not facing upwards?
  4. If this aligns with what we see now, does this look close to pinning? If not, what is missing in the current alignment?
  5. The fragment looks like a small bulge later with the current position. I am fine with this as long as that will not disturb me functionally or strength-wise. Even with pinning, there is the possibility of a small bulge, or there will not be any bulge?
Answered by Dr. Atul Prakash

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.

Patient's Query

Hello doctor,

Thank you for the reply.

I had a similar injury to the middle finger 12 years back. I did not check anything that time since I was unaware that it could have been a fracture, and it healed with the deviation as you see in the picture. It is 80 to 90 % functional. However, slight pain was there for at least six months. Will this new finger be like that?

Answered by Dr. Atul Prakash

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.

Answered byDr. Atul Prakash

Medically reviewed byiCliniq medical review team

Published At July 31, 2022
Reviewed AtOctober 16, 2023

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Atul Prakash
Dr. Atul Prakash

Orthopedician and Traumatology

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