Overview
The phalanges are the bones of the fingers and thumb. Each finger has three: the proximal phalanx (closest to the hand), the middle phalanx, and the distal phalanx (fingertip bone). The thumb has two. These small bones fracture frequently from crush injuries, direct blows, or sports contact, and most heal well with splinting or buddy taping (taping the injured finger to the one beside it for support).
Surgery is reserved for fractures that are displaced (the bone ends have shifted out of position), rotationally malaligned (the finger points in the wrong direction when bent), intra-articular (the fracture line enters a joint surface), or otherwise too unstable to hold with external splinting alone. The threshold for operating on phalangeal fractures is set more by rotation and joint involvement than by the angle measured on an X-ray. Even a small rotational error, one that looks minor on film, can cause the injured finger to overlap its neighbor during a grip, which is noticeable with every use of the hand.
Open reduction and internal fixation (ORIF) is the general term for surgically repositioning the fracture fragments and holding them with hardware such as small screws, pins, or a miniature plate. The hand is a precision instrument, and the goal of surgery is to restore anatomy precisely enough that the tendons gliding across the bone can move freely and the finger heals straight, correctly rotated, and with full joint motion.
Tendon adhesions (scarring that sticks tendons to the repair site) and stiffness are the most common complications of any phalangeal surgery, which is why hand therapy typically begins within days of the operation even while the repair is protected.
Why it's done
Phalangeal ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Rotational malalignment
The injured finger crosses over its neighbor when you bend the fingers toward a fist.
Intra-articular fracture with step-off
A step in the joint surface leads to stiffness and arthritis.
Unstable oblique or spiral fracture
An angled or spiral fracture line that keeps shortening or shifting despite splinting.
Open fracture or associated tendon injury
A fracture through the skin, or one with a tendon injury, needs urgent surgical exposure and stabilization.
How it works
Options include thin pins placed through the skin under live X-ray guidance (percutaneous K-wires), screws that compress an angled fracture line back together (lag screws), and low-profile plates and screws for fractures that are shattered or involve a joint surface. Incisions are kept small to minimize scarring and stiffness.
Hand therapy is often started in the immediate postoperative period even when pins or plates are in place.
Recovery
The hand is splinted briefly and then started on early protected motion guided by a hand therapist. Pins are removed in the clinic once the bone is healing reliably. Stiffness, tendon adhesion, and malunion are the main complications. Most people regain functional motion with diligent therapy over time.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or schedule an appointment online.
Physicians Who Perform Finger Fracture Fixation
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus (the new bone that bridges a fracture) and remodels bone. Completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. This procedure is offered because the condition, when left untreated, can cause a finger that heals crooked, where a rotational malunion is felt with every grip and can significantly impair hand function. The decision to proceed weighs the risks of surgery against the limitations the condition places on daily function. Surgery does not remove risk; it addresses a problem that is otherwise progressive. Whether it is appropriate is determined for each patient in consultation with the surgeon.
The risks we discuss before phalangeal ORIF include:
- bleeding and infection
- anesthesia risk
- stiffness (the greatest threat in any phalangeal fixation)
- tendon adhesions
- hardware irritation
- non-union (uncommon)
- scar tenderness
The indication to proceed is an unstable or displaced phalanx fracture, particularly one with rotational malalignment. Patients who don't need this operation don't get it.
Frequently Asked
questions we hear in clinicDoes a broken finger always need surgery?
No. Most phalangeal fractures heal well with splinting or buddy taping, which is taping the injured finger to the one beside it for support. Surgery is reserved for fractures that are displaced, rotationally malaligned, entering a joint surface, or otherwise too unstable to hold with splinting alone.
Why does rotation matter so much?
The threshold for operating is set more by rotation and joint involvement than by the angle measured on an X-ray. Even a small rotational error, one that looks minor on film, can cause the injured finger to overlap its neighbor during a grip, which is noticeable with every use of the hand.
What kind of hardware is used?
Options include thin pins placed through the skin under live X-ray guidance, screws that compress an angled fracture line back together, and low-profile plates and screws for fractures that are shattered or involve a joint surface. Incisions are kept small to minimize scarring and stiffness.
Why does hand therapy start so soon after surgery?
Tendon adhesions and stiffness are the most common complications of any phalangeal surgery. That is why hand therapy typically begins within days of the operation, even while the repair is protected and even when pins or plates are in place.
Do the pins come out?
Yes. Pins are removed in the clinic once the bone is healing reliably.
Will I get my finger motion back?
Most people regain functional motion with diligent therapy over time. The hand is splinted briefly and then started on early protected motion guided by a hand therapist.
Further Reading
External patient-education references and related OSI pages for additional background: