The thing that matters most: rotation
A broken finger can look perfectly acceptable on an X-ray and still be badly wrong, because an X-ray is a flat picture and rotation does not show on it.
When you close your hand, your fingers do not stay parallel. They converge, all pointing towards the same spot near the wrist. A fracture that has twisted even slightly breaks that convergence, and the finger crosses over or under its neighbour when you make a fist. It is obvious when you look for it and invisible when you do not.
A rotated finger is a functional problem, not a cosmetic one. It catches on things, it interferes with grip, and it does not correct itself as the bone heals. So the first question at any appointment for a broken finger is not what the X-ray shows. It is make a fist, slowly, and let me watch.
If your fingers cross over when you close your hand, say so, whatever you have been told about the X-ray.
Symptoms
Most people describe:
- Pain, swelling and bruising over the broken bone
- A finger that looks bent, shortened, or that crosses its neighbour when the hand is closed
- A knuckle that has lost its normal prominence, common after a punch
- Pain on gripping, and difficulty making a full fist
- Stiffness that sets in quickly, often within days
How it is diagnosed
By examination and X-ray, and in that order. The X-ray shows the fracture, how much it has angled and whether it runs into a joint. The examination shows rotation, which the X-ray cannot, and tells us whether the fracture is stable when the finger moves. A CT is occasionally useful where the fracture involves a joint surface and the plan depends on the detail.
Non-surgical treatment
Most hand fractures are treated without an operation, and this is the right answer rather than a compromise.
The bone is held in an acceptable position with a splint, or by taping the injured finger to the one beside it so the neighbour acts as a splint while the two move together. Our hand therapists make the splint to fit, which matters more than it sounds, because a splint that holds the wrong joints is how hands stiffen.
Movement starts early and deliberately. The joints not needed to protect the fracture are kept moving from the outset, and the fracture itself is moved as soon as it is stable enough to allow it. A hand fracture that heals perfectly in a stiff hand is not a good result.
Surgery
Two things decide whether a fracture is better fixed than splinted, and rotation is the first of them.
- Rotation. Any rotational deformity. It will not correct with healing and it directly costs you grip.
- Shortening or angulation beyond what the finger will tolerate. Different bones tolerate very different amounts, so this is a judgement about that bone rather than a single number.
- A fracture running into a joint, where the joint surface has stepped and would heal uneven.
- Instability. The fracture will not hold its position in a splint, or slips once movement starts.
- An open fracture, where the bone has broken through the skin, or multiple fractures in the same hand.
Pinning through the skin
Fine wires are passed through small punctures to hold the bone, usually without opening the fracture at all. The fracture is lined up under X-ray guidance and the wires hold it there while it heals. The wires sit under or just through the skin and are removed once the bone has united.
[CONFIRM: when the wires come out, and whether that is done in the rooms.]
Open fixation
The fracture is exposed and held with screws, or with a small plate and screws. This is used where the bone cannot be reduced without seeing it, where a joint surface needs rebuilding, or where the fracture needs to be stable enough to move immediately. The advantage is that fixation of that quality allows movement within days rather than weeks. The cost is a wound and the scarring that goes with it, in a place where tendons glide, so it is not the default.
[CONFIRM: operating time and anaesthetic for hand fracture fixation, and whether that differs between pinning and open fixation.]
Recovery, week by week
Indicative, and it varies with which bone, which finger and how the fracture was treated.
Timeframe
What to expect
Day of surgery
The hand may feel numb or tingly for several hours because of the local anaesthetic. You can move the fingers not included in the dressing before you leave hospital.
Days 1 to 7
Keep the dressing clean and dry, and keep the hand elevated. You will see the hand therapist, who replaces the dressing with a custom made removable splint.
One to two weeks
Progress reviewed and the wound checked. Guided movement begins out of the splint, with the therapist deciding what can safely move and how far.
Two to four weeks
Movement is progressed steadily. The splint is worn between exercises and at night. Light use of the hand, no gripping hard and no loading.
Four to six weeks
Most fractures have united enough for splinting to be reduced or stopped, and for strengthening to begin. Buddy taping may continue for protection.
Six weeks onwards
A graded return to full use and to heavier work and sport, guided by your hand therapist.
Two to three months
Swelling and stiffness in the finger continue to settle. A fractured finger that is still slightly swollen at three months is normal rather than a problem.
Driving and work
Driving at one to two weeks, depending on which digit is involved and on whether you can steer safely. Office work one to two weeks. Light manual work four to six weeks. Heavy work after six weeks.
Hand therapy
This is the part that decides the result. A hand fracture is rarely difficult to heal and frequently difficult to move afterwards, and the therapist is the one managing that tension, protecting the bone while keeping everything that can safely move on the move. Our therapists work on site, so the splint is made within days of the injury and adjusted whenever the fracture allows more.
Risks and complications
Surgery for hand and finger fractures is routine and complications are uncommon. They can include:
- Wound healing problems or infection, including infection around a wire where it passes through the skin.
- Bleeding or bruising.
- Stiffness of the finger, which is the most common problem after any hand fracture and the main reason therapy matters.
- Tendon irritation or adhesion, where scar tissue restricts the glide of a tendon over the fracture site.
- Nerve injury, causing a numb patch near the incision.
- Failure of the bone to unite, or healing in an imperfect position.
- Metalwork that needs removing later.
- Ongoing swelling and tenderness, which is common for some months.
When to be seen sooner
Go to an emergency department, or contact us, if you have:
- A finger that crosses over or under its neighbour when you make a fist
- An obvious deformity, or bone visible through the skin
- A wound over a knuckle from striking someone in the mouth. These become infected reliably and need treating urgently whatever the X-ray shows
- A finger that is numb, pale or cold
- Increasing pain and swelling in a splint or cast
If you have had surgery with us and have questions or concerns afterwards, phone the rooms during office hours on (08) 7127 0365.
Frequently asked questions
The X-ray looks fine but my finger crosses over. Does that matter?
Yes, and it matters more than the X-ray. Rotation does not show on a flat film, and it does not correct as the bone heals. A finger that crosses its neighbour when you make a fist catches on things and costs you grip. It is one of the clearest reasons to fix a fracture that would otherwise be splinted, so say so if you can see it.
Does a broken finger always need a cast?
No, and a rigid cast over the whole hand is usually the wrong treatment. Most hand fractures do better in a fitted splint, or taped to the neighbouring finger, with movement starting early. Immobilising a hand for six weeks reliably produces a stiff hand, and stiffness is harder to fix than the fracture was.
I punched something and cut my knuckle. Is that different?
Yes, and it is the one injury on this page that should not wait. A wound over the knuckle caused by striking someone in the mouth inoculates the joint with bacteria, and it becomes infected almost reliably. It needs urgent treatment, usually washing out the joint, whatever the X-ray shows and however small the cut looks. Please say honestly how it happened. It changes the treatment entirely and nobody is interested in judging you.
Will my finger be permanently swollen?
It will be swollen for longer than you expect, and in many people the injured finger stays very slightly thicker than the other side permanently. That is the soft tissue rather than the bone. Swelling that is still settling at two to three months is normal.
Do the wires have to come out?
Yes. Wires used to hold a hand fracture are temporary and are removed once the bone has united. It is a quick procedure.
[CONFIRM: timing, and whether it is done in the rooms or in theatre.]
When can I drive and go back to work?
Driving at one to two weeks, depending on which digit is involved and on whether you can control the wheel safely. Office work at one to two weeks. Light manual work at four to six weeks. Heavy work after six weeks. There is no legislation covering surgery and driving, so the test is whether you can control the car safely, including in an emergency. Some insurers will not cover damage or liability if you had recent surgery, if you were wearing a splint while driving, or if you were taking pain medication that could affect your driving.
Why does a small broken bone need so much therapy?
Because the hand stiffens far more readily than it fails to heal. Getting the bone to unite is rarely the hard part. Keeping the joints moving while it does, and recovering the movement afterwards, is where the result is actually won or lost.
What does the surgery cost?
You will receive written informed financial consent setting out the surgeon, anaesthetist and hospital fees, your Medicare rebate and your health fund's contribution before anything is booked. Phone the rooms on (08) 7127 0365 for an estimate.
Do I need a referral?
A referral from your GP or another specialist means you can claim a Medicare rebate on the consultation. We can see you without one, but the rebate will not apply.
Written and clinically reviewed by Dr Paul van Minnen, MD, PhD, EBOPRAS, FRACS (Plast)
Last reviewed 11 September 2026