Second opinion on broken finger - surgery?

[Otto]

This might seem like an odd request, but if anyone has any experience in these matters I'd love some extra input as my orthpedic surgeon really didn't convince me one way or the other.

I broke my finger - jammed it playing football, and the tendon pulled a chunk of bone off. Surgeon said it would most likely heal on its own in a splint, but has given me the option of surgery to put screws in, as the bone is somewhat seperated (See x-ray below), and this would give a slightly 'better' repair. I have to pay for the surgery (I live in the US and it is below my deductible). I can afford it, but it's not pennies.

My concerns are obviously there are risks with surgery - although only local anesthetic, they are cutting into me, and drilling some screws into bone. It's my left hand (middle finger) and I am right-handed, but I do play guitar a little (as a hobby).

Would really appreciate some totally impartial advice if anyone can offer it.

Xray below!

[Gnits]

You lucky lucky b'stard!
If it were a snapped tendon you prob won't get offered surgery and mine took over a year to heal. With a bone fragment the healing time is much much less.
I'd go with the surgery, saves the proximal joint from seizing up too much.

[K77 CTR]

I'd probably leave it alone and see what happens, would think surgery will be an option in the future if needed. It's your non dominant hand and not a particularly important digit depending on how important guitar playing is to you.

[The_Doc]

Otto said:

Greater than half the articular surface involved and > 1mm displacement of said articular surface. Plus it's the extensor insertion onto the distal phalanx.

If it was MY finger, I'd have it fixed and I'd pick my surgeon myself.

I cannot advise you however, just give an indication. This is not a second opinion.

[The_Doc]

K77 CTR said:

I'd probably leave it alone and see what happens, would think surgery will be an option in the future if needed.

Once 6 weeks have passed, well 3 really, the door is closed on surgery of a reconstructive nature. It will be salvage options then.

[The_Doc]

Gnits said:

I'd go with the surgery, saves the proximal joint from seizing up too much.

no evidence of this.

either treatment route may give equal chance of keeping range of movement. Both options could lead to a stiff, dropped terminal phalanx (end bit)

Sorry to hog the thread here, but bones is my thing.

[Stu R]

I'd probably go with the surgery, on account that I didn't when I broke two of mine and my fingers are knackered - I can pick my nose and scratch my arse at the same time they're that wonky, and one of them is stiff as a board, particularly in winter it seems.

[Otto]

The_Doc said:

no evidence of this.

either treatment route may give equal chance of keeping range of movement. Both options could lead to a stiff, dropped terminal phalanx (end bit)

Sorry to hog the thread here, but bones is my thing.

Please don't apologise - your indications are extremely valuable. Out of interest, if there are equal chances of keeping range of movement, what would lead you to choose surgery? Especially given the somewhat invasive nature?

Even now, the end is actually pretty straight, so I'm not too concerned about the aesthetics, mainly movement and obviously would like to avoid pain in the future / get the easiest healing.

[The_Doc]

Otto said:

Please don't apologise - your indications are extremely valuable. Out of interest, if there are equal chances of keeping range of movement, what would lead you to choose surgery? Especially given the somewhat invasive nature?

Surgery done well can 'put the pieces of the jigsaw back together' and in the body this usually tends towards the better outcome. It's not a clear cut case though, and I haven't examined you, or made a full assessment, so there's no way I can give you an answer, just give general pointers.

If you are paying for your care then your surgeon should see you again and provide more of a discussion before you commit. Sadly, he makes more money out of all if he operates; which is the real joy of the NHS in the UK. I get paid whether I operate or not (broadly)

[Gnits]

Can tell you from recent experience that splinting for such an extended period leads to lack of use of the digit and that the splint interfers with flexion. Splint came off mine but took over 6 months to be able to flex fully.
However, it has healed rather well and only has a very slight lag and each case will differ I guess

[Otto]

The Doc - thank you so much for your insite, I really appreciate your input.

Thanks others as well!