Broken Knuckle

Identifying and Treating a Broken Knuckle

 

A broken knuckle can be a difficult thing to diagnose without an x-ray. What one might consider to be a “broken knuckle” is commonly known as a boxer’s fracture because this type of injury is frequently experienced by boxers. If you’ve recently punched something…say a brick wall or an unsuspecting foe’s face…then you might be experiencing symptoms that point to a fracture.

 

Hand Biology

 

What we usually refer to as the four “main knuckles” are actually the ends of metacarpal bones—that is, the long bones in the top of your hand. Attached to each metacarpal is a proximal phalanx, of which there are four. Together these bones create the flattened part of your fist that connects with whatever it is that you’ve decided to punch. Although these bones work pretty well to smash things on occasion, it really isn’t what they were meant to do. They form a series of joints (yes, knuckles) that, when used together, allow your hands to bend and grab onto things, like the handlebars of a bike.

 

What Happens When a Knuckle Breaks

 

Typically when you break a knuckle it is actually a portion of the metacarpal bone just below the knuckle that has been fractured. The end piece of the metacarpal (the knuckle itself) is round and tough but as you begin to trail down a centimeter or two towards the center of the hand this bone narrows into what you might call a ‘neck’.  As your knuckle comes into contact with something that’s very hard, the narrowed portion of this bone can’t handle the force and breaks. The type of punch you throw could have quite a lot to do with which knuckle(s) is most likely to be broken. What is traditionally known as a boxer’s fracture involves the second or third metacarpals being broken, that is the pointer and middle finger. This is because boxers—or those who have trained to throw punches correctly—use a straight punch that results in most of the force being exerted onto the index and middle fingers. The opposite of this fracture is called the “brawler’s fracture,” which typically involves fractures of the fourth and fifth fingers—or the ring and pinky fingers. As its name implies, this type of fracture is the result of impaired or untrained punching where the last two fingers of the hand sustain the brunt of the punch’s force.

 

Symptoms of a Broken Knuckle

 

As we mentioned before, it can sometimes be difficult to diagnose a broken knuckle without the aid of an x-ray, especially when a minor or hairline fracture has occurred. In cases like this the most obvious symptoms would be pain that occurs when the hand is used or the knuckle is flexed or touched. The area will undoubtedly be tender around or near the affected knuckle. You might have been able to hear a snap or loud popping sound at the time of impact, in which case you would likely be right in suspecting that you have a broken knuckle. It is also very common for the knuckle area to swell and even change color as bruising and inflammation set in. The knuckle itself may or may not be in a different position than usual. A bad break can snap the metacarpal bone altogether which might make your knuckle difficult to see when a fist is made, or it might result in your knuckle moving further back into your hand. This type of break should be treated by a doctor.

 

A cut on the skin of the injured finger could be a sign that a bad break has occurred and should also warrant a trip to the doctor. General swelling of the hand, redness, stiffness, and difficulty moving the injured finger or the hand are also good signs that a break has indeed occurred.

 

Treating a Broken Knuckle

As long as your knuckle hasn’t been displaced to another position and there isn’t a cut on the skin, then you may be able to get by with treating yourself at home. Most doctors can set the bone in a cast or by taping it to a neighboring finger, but in most cases you can do this yourself. The first thing you should do after the injury is to apply an ice pack to the knuckle and hand. Keep the hand relaxed during this time and try to keep ice on it for no more than 20 minutes and then remove it for an hour. Keeping your skin at such a cool temperature for more than 20 minutes could actually damage the tissues there. After an hour of rest you can apply the ice for another 20 minutes. Keep this up for about four hours. Also try to keep the hand elevated above heart level which, in conjunction with the ice, will seriously decrease the swelling around the joint.

 

After you have brought down the swelling you need to immobilize the finger. To do this you can use ace bandage and tape or first aid tape. Get a friend to wrap your injured finger side-by-side with a neighboring finger. Make sure the tape is snug but not so tight that your fingers start to discolor. By stabilizing your finger you are allowing the bone to heal without added aggravation from the surrounding tissues. The initial healing period is probably going to be between four and six weeks, although the strength in the affected hand may not return to normal for several months.