Definition

An avulsion fracture occurs when a small piece of bone, attached to a tendon or ligament, is pulled away from the main bone structure. Tendons connect muscles to bones, while ligaments hold bones, joints, and organs in place.

In this type of fracture, the bone shifts slightly in one direction, and the tendon or ligament moves in the opposite direction, carrying the small bone fragment with it. This typically happens during sudden changes in position or direction.

Avulsion fractures can occur in any bone connected by a tendon or ligament. The bones most commonly affected by avulsion fractures are:

• Elbow

• Heel

• Foot

• Knee

• Fingers

• Wrist

• Pelvis

• Spine

This article will specifically focus on digital avulsions, which are also referred to as mallet finger or baseball finger.

Causes

The most frequent causes of digital avulsions are contact sports such as kickboxing, baseball, softball, and football. These sports involve a lot of hand contact, which can put stress on the ligaments and tendons that support the bones. Repeated stress or pressure on these areas can lead to digital avulsions.

Risk Factor

While digital avulsions can affect anyone, certain groups are more prone to this injury:

Children

Children experience rapid growth spurts, which can increase the risk of avulsions in the bones, particularly in the fingers. Tendons and ligaments surrounding the growing bones may become stretched, causing pain and fractures. Children who are active in sports are also at greater risk of digital avulsions.

Athletes

Sports that involve high impact, frequent twisting motions, or rapid direction changes are known to increase the risk of digital avulsions.

Dancers

Dancers, especially those in ballet, who place significant weight on their toes and perform sudden movements, are at higher risk for digital avulsions due to the stress placed on their tendons and ligaments.

Symptoms

Digital avulsions typically present with severe, sudden pain, followed by the following symptoms:

• Bruising, swelling, or muscle pain around the affected area.

• A cracking sound at the site of the injury.

• Pain that may radiate to the surrounding areas.

• Difficulty moving the fingers or toes.

• Cramping or tingling sensations in the affected area.

Diagnosis

Digital avulsions can often be mistaken for strains, nerve irritation, or chronic pain without a clear cause. A thorough diagnosis is crucial to avoid misdiagnosis. The doctor will perform an interview, physical examination, and possibly additional tests to confirm the diagnosis.

Medical Interview

The doctor will begin by asking about:

• The patient's primary complaints and any accompanying symptoms.

• Occupational history and daily activities.

• A history of previous injuries or conditions.

• A record of past illnesses.

• A history of any medications taken.

Physical Examination

The doctor will first conduct a general examination, assessing the patient’s overall condition, including vital signs such as blood pressure, body temperature, respiratory rate, and pulse.

Following this, the doctor will perform a localized examination of the painful area. While digital avulsions typically do not show visible abnormalities, the doctor will look for signs of bruising or swelling. The doctor will palpate the affected area and apply pressure to check for sharp pain, which is common in avulsion fractures. They will also move the affected finger to assess for restricted movement.

Diagnostic Tests

To confirm the diagnosis, the doctor may recommend radiological tests such as X-rays or CT scans. X-rays are helpful in assessing the integrity of the bones and joints, while CT scans provide detailed images of the bones, joints, and surrounding tissues, helping to identify the extent of the injury.

Management

To manage a digital avulsion, you can start by applying a cold compress to the injured finger to reduce pain and swelling. Non-steroidal pain relievers, such as paracetamol, can also help alleviate discomfort. If you have a history of drug allergies, it is best to consult a doctor before taking any medication.

The affected finger should be kept rested to avoid complex movements, which will help promote healing. Assistive devices such as braces, splints, or casts can be used for less severe digital avulsions. These devices help improve the function of the injured finger. The duration of using assistive devices depends on the severity of the injury, usually ranging from two to six weeks.

Physiotherapy is often recommended once any bone, tendon, or ligament abnormalities are ruled out and as the mobility of the finger returns gradually. The goal of physiotherapy is to restore the finger's full range of motion and function.

Surgical Management

In some cases, surgery may be needed, especially if the finger avulsion leads to joint instability. Since the fingers are small and delicate, surgery is typically performed by an orthopedic surgeon with specialization in hand surgery. Complete healing and return to normal activities generally take up to 12 weeks following surgery.

Complications

If not treated properly, digital avulsion can lead to complications such as permanent disability or a reduced range of motion in the affected finger.

In children, digital avulsion can potentially interfere with cartilage growth, which makes it essential to perform a thorough examination to avoid growth issues.

Prevention

Preventing digital avulsion can be difficult, especially for those at higher risk, as these injuries often happen suddenly. However, you can take the following steps to minimize the risk:

• Spend 5–10 minutes warming up before physical activity, paying attention to both the fingers and toes.

• Avoid forcing difficult movements or maneuvers, especially if you're already experiencing pain in your fingers or joints.

• Ensure you meet your calcium needs by consuming a balanced diet, which includes milk, cheese, fish, and eggs. Sufficient calcium intake reduces the risk of fractures.

When to See a Doctor?

If you experience an injury to your finger or toe accompanied by the symptoms mentioned above, it’s important to visit the emergency room immediately. The doctor will examine your condition and determine if it’s a digital avulsion.

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