Thumb Fracture

What is Thumb Fracture

Thumb fracture is a break in one of the two bones in your thumb. The bone that goes from the tip of your thumb to the first joint in your thumb is called the distal phalanx. The bone that goes from the first joint to the joint at the base of your thumb is called the proximal phalanx.

Fractures that happen at the joints of your thumb are harder to treat. A broken thumb is more serious than a break in one of your other fingers because you need your thumb for grasping. Thumb fractures are also more likely to lead to pain and stiffness years after healing (arthritis).

What are the causes?

A thumb fracture may be caused by:

  • A hard, direct hit to your thumb.
  • Your thumb being pulled out of place.

What increases the risk?

You may be more likely to break your thumb if you:

  • Participate in sports such as wrestling, hockey, football, or skiing.
  • Have a condition that causes your bones to become thin and brittle (osteoporosis).

What are the signs or symptoms?

Symptoms may include:

  • Sudden severe pain.
  • Swelling.
  • Bruising.
  • Not being able to move the thumb.
  • An abnormal shape of the thumb (deformity).
  • Numbness or coldness.
  • A red, black, or blue thumbnail.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your symptoms and medical history.
  • A physical exam.
  • Imaging studies such as X-ray, ultrasound, or MRI.

How is this treated?

Treatment for this condition depends on how severe your fracture is.

  • At first, you may need to wear a padded splint until you can get a cast or have surgery. The padded splint protects your thumb and keeps it from moving.
  • If the broken pieces of your bone line up with each other (good alignment), you will need to wear a splint or a cast for up to 4–6 weeks.
  • If your fracture is severe, your health care provider will need to align the bone pieces. Your health care provider may:
    • Move the bones back into position without surgery (closed reduction).
    • Do surgery to align the fracture and put in metal screws, plates, or wires to hold the bone pieces in place (open reduction and internal fixation, ORIF).
    • Do surgery to align the fracture and put in pins that are attached to a stabilizing bar outside your skin to hold the bone pieces in place (external fixation).
  • In all cases, treatment may involve:
    • Wearing a splint or cast for up to 6 weeks.
    • Follow-up visits with your health care provider and X-rays to make sure you are healing.
    • Physical therapy after your cast is removed.

Follow these instructions at home:

If you have a splint:

  • Wear the splint as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the splint if your thumb or fingers tingle, become numb, or turn cold and blue.
  • Keep the splint clean and dry.

If you have a cast:

  • Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
  • Check the skin around the cast every day. Tell your health care provider about any concerns.
  • You may put lotion on dry skin around the edges of the cast. Do not put lotion on the skin underneath the cast.
  • Keep the cast clean and dry.

Bathing

  • Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
  • If your splint or cast is not waterproof:
    • Do not let it get wet.
    • Cover it with a watertight covering to protect it from water when you take a bath or shower.

Managing pain, stiffness, and swelling

  • If directed, put ice on your thumb:
    • If you have a removable splint, remove it as told by your health care provider.
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag, or between your cast and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Raise (elevate) your hand above the level of your heart while you are sitting or lying down.

Activity

  • Ask your health care provider what activities are safe for you.
  • After your cast is removed, do physical therapy exercises as directed. Your health care provider may recommend that you:
    • Move your thumb in circles.
    • Touch your thumb to your pinky finger.
    • Do these exercises several times a day.
  • Ask your health care provider if you may use a hand exerciser to strengthen your muscles.
  • If your thumb feels stiff while you are exercising it, try doing the exercises while soaking your hand in warm water.

General instructions

  • Do not put pressure on any part of the cast or splint until it is fully hardened, if applicable. This may take several hours.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Do not drive until your health care provider approves. Do not drive or use heavy machinery while taking prescription pain medicine.
  • Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay bone healing. If you need help quitting, ask your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if you have:

  • Pain that gets worse.
  • A fever.
  • A bad smell coming from your cast or splint.

Get help right away if:

  • Your thumb feels numb, tingles, turns cold, or turns blue.
  • You have redness or swelling that gets worse.
  • You have severe pain.

Summary

  • A thumb fracture is a break in one of the two bones in your thumb.
  • Treatment involves wearing a splint or cast to keep the thumb from moving until it heals. Sometimes surgery is needed.
  • Make sure you understand and follow all of your health care provider’s home care instructions.
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