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  You are at: Procedure info > Hand Surgery > Broken knuckles
   
   

Broken knuckles

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What is a knuckle?

The knuckle is the hard lump that is felt on a clenched fist. The hand is made of the phalanges, which are the finger bones, and the metacarpal bones which span across the palm from the wrist to the fingers. If you press firmly on the back of your hand, you can feel the hard lines of the metacarpal bones.

The phalanges can be broken very easily in sport or accidents. To learn more about these, please read our article on broken fingers.

The knuckle is the end part of the metacarpal bone, which shows when making a fist.

 

How can a knuckle be broken?

One of the common ways to get a broken knuckle is by punching a wall. Often, the little finger knuckle will be the one that is broken, although the neighbouring knuckles can also be broken with a hard punch. Sometimes, the knuckle can be broken when punching someone else or even the floor.

Occasionally, broken knuckles occur in accidents such as falls or road traffic accidents.

 

How can I tell if my knuckle is broken?

The first symptom of a broken knuckle is pain- this is worse when the knuckle is pressed. Bruising, of course, can also cause pain so this is not 100% reliable.

 
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If your knuckle has 'disappeared' or sunken in, then it is likely to be broken.

Also, when you clench your fist, do your fingers curl up correctly? If your fingers cross over when clenching (and they did not before the injury), then your knuckle may be broken. Even if they are normal, though, the knuckle could still be broken.

The only way to be sure is with an x-ray. For this reason, if you have any concerns about having a broken bone, always seek medical advice.

 

What is the treatment for broken knuckles?

This depends on a number of factors, including the type of break, your age, job, hobbies etc.

The most common form of treatment is by neighbour strapping - the finger with the broken knuckle is taped to the next-door finger. This is usually for about 3 weeks.

If this is not possible, a splint may be needed, often in the form of a plaster cast. Again, this is for about 3 weeks.

If this treatment fails or if your break requires, then surgery may be needed.

 

 

What surgery may be needed for broken knuckles?

  • K-wires - Kirschner, or 'K' wires are thin metal rods that are passed across the broken knuckle bones. These hold the break in place until it is healed, usually three weeks later. The wires are usually left with a short length exposed at the skin, and can be removed with very little discomfort by simply pulling them out with special pliers. The wires need to be kept clean while they are in place, as bacteria could otherwise track to the broken area to cause a bone infection - this is very hard to then treat and could lead to serious consequences

  • Interosseous wires - these are thin wires, much like fuse wires. They are used to tie the broken knuckle bones together. Often, these can be left in place permanently

  • Plate fixation - small metal plates are used to span the broken bones, being held in place with small screws. The plates are left in the hand permanently, often un-noticed. Plates are usually used for breaks of the metacarpal that are in the mid-palm area rather than at the knuckle itself

  • External fixation - complex knuckle breaks may need this form of treatment to hold fragments in place while they heal. Usually, a thick pin is placed through the skin into the bone either side of the break. A metal bar then spans between the pins, keeping them and therefore the bones still. This is kept in place until the break is healed, usually three to four weeks.

 

 

What complications can occur with broken knuckles?

  • Delayed union - this is where the break takes longer to heal than expected. Whilst this can be an inconvenience, it still results in a fixed bone

  • Mal-union - the broken bones heal in a poor position. If this causes problems with hand function, then further procedures on the knuckle may be needed

  • Non-union - the broken bones do not heal, even after many weeks. Further procedures may be needed

  • Infection - infected bone is called osteomyelitis, and can be extremely hard to treat. A lengthy course of antibiotics or further surgery can clear the infection, although occasionally the infection does not clear and can even, in a worst case scenario, lead to amputation of the affected finger

  • Stiffness - this is a common result of having a broken knuckle. Due to a combination of splinting and the break itself, the affected finger may never gain the same movement as before the injury. Physiotherapy helps to reduce this risk

  • Pain - well-healed broken bones often cause little problem, although it is quite common to get 'niggling' aches and pains in the fracture area, especially during cold weather or when using the hand for heavy work

 

Other relevant SurgeryWise articles: fingertip breaks, broken fingers, fractures, hand surgery, mallet finger, broken knuckle strapping

 

 

 

Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.

The information provided is as a guide only and you should discuss matters fully with your specialist before deciding the right procedure for you. Please also read our disclaimer

 

 

 
 
 
 
 

 

 

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