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Phalangeal fracture fixation
Phalangeal fracture fixation is a surgical procedure that stabilises a broken phalangeal bone using wires, plates, or screws to hold the fragments in correct alignment while they heal. It is used when a fracture is displaced, unstable, or involves a joint surface, helping restore finger alignment, movement, and strength.
At a glance
Anaesthetic
Commonly general anaesthetic
Where
The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately one week after surgery
Driving
Not until you can grip the wheel strongly and safely control the vehicle, which may be six weeks after surgery
Post Operative Hand Therapy
Required for splinting, range of movement exercises and scar management
Splinting
Yes - splint worn while healing; duration depends on the fracture location and fixation method
Pain relief
Usually paracetamol and/or ibuprofen; stronger pain relief may be needed initially
Return to repetitive & heavy loading
Usually 6-8 weeks depending on fracture healing
Surgical fixation of a broken finger bone
Phalangeal fracture fixation is surgery to realign and stabilise a broken finger bone (proximal, middle or distal phalanx) when the fracture is displaced, unstable, rotated, or involves the joint surface.
Who is this procedure for?
- People with a displaced or unstable phalangeal fracture, where the bone fragments have shifted out of position
- People with a rotational deformity, where the finger crosses over its neighbour when making a fist
- People with an intra-articular fracture (involving the joint surface) that is displaced
- Not needed for stable, undisplaced fractures, which are usually treated with buddy-strapping or splinting alone
What does the surgery involve?
Proximal and middle phalanx fractures are often treated with closed reduction and K-wire fixation (temporary wires passed through the skin), or with open reduction and internal fixation (ORIF) using a plate and screws for more complex or unstable patterns. Distal phalanx (tuft or shaft) fractures are usually treated with splinting alone unless significantly displaced, in which case a K-wire may be used. Mallet fractures (a specific distal phalanx fracture involving the extensor tendon insertion) are addressed separately – see the Mallet Fracture Repair page. Dr Tomlinson will recommend the method best suited to your specific fracture.
Alternatives to surgery
Surgical fixation is one option for a phalangeal fracture. Depending on your situation, the alternatives may include:
- Buddy-strapping or splinting alone: appropriate for stable, undisplaced fractures without rotational deformity
- Closed reduction (manipulation) alone: for some displaced but reducible fractures, followed by splinting
- K-wire fixation versus ORIF: the choice depends on the fracture pattern, stability and location
What happens if left untreated: a displaced or rotated fracture is likely to heal in a poor position, causing the finger to cross over its neighbour, reduced grip, and stiffness.
Dr Tomlinson will discuss which options suit your specific fracture at your consultation.
Frequently Asked Questions
Where will my surgery be done?
At The Avenue Hospital.
How much time will I need to have away from work?
This depends on what your job involves and which finger and fixation method are used. If your work is desk-based, you may return relatively soon with the finger protected. If your work is physical or requires fine grip, you’ll usually need longer, until the fracture has healed sufficiently. Dr Tomlinson will give you advice tailored to your job and fracture at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand and finger was treated, whether you’re wearing a backslab or splint, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You must be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for six weeks after a structurally significant finger fracture.
When can I do a full day of administrative or desk work?
Often from 1-2 weeks after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions.
How long will I need to wear a splint?
A splint is worn while the fracture heals, typically 6 weeks depending on the fracture location and method of fixation. K-wires, if used, are usually removed at 3-4 weeks for most phalangeal fractures.
Will I need to see a hand therapist afterwards?
Hand therapy is required, particularly for proximal phalanx fractures, since the extensor tendon mechanism runs very close to the bone and stiffness is a common complication if movement is not carefully guided during healing.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Stiffness of the finger from tendons adhering to the fracture site or hardware, sometimes needing further surgery (tenolysis) to release them
- Malunion or nonunion of the fracture
- Infection at a pin site or around a plate
- Irritation from hardware, sometimes requiring removal
- Reduced finger movement while the fracture heals
Anaesthetic
Your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to minimise bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time.
First week
Keep the dressing dry and intact until your post-operative review. You may move any joints that are not immobilised within a splint. However, you must not lift objects greater than 300 grams in weight with your fractured hand. Take paracetamol and ibuprofen as required for discomfort. You should find that your discomfort lessens and your range of movement improves each day.
Second week
K-wires, if used, remain in place and the finger must not be moved to avoid bending or breaking the wires. After ORIF, guided movement is encouraged early to reduce stiffness, under the direction of your hand therapist. Your hand therapist and surgeon will provide you with individualised instructions on wound care, splinting, range of movement exercises and loading.
6 weeks
Strength, movement and function vary at 6 weeks depending on the fracture pattern, treatment and bone healing. If your x-ray shows satisfactory bone healing you will be permitted to remove your thermoplastic splint and return to usual activities. Full strength of your bone and of your muscles is expected to return in the subsequent weeks. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
Most fractures are healed by 6 weeks, though stiffness can take longer to fully resolve, particularly after proximal phalanx fractures. K-wires are removed at 3-4 weeks; plates and screws are not routinely removed.
Want to know more about Phalangeal Fracture Fixation?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.