Rafael (fictitious name) was walking his dog when the animal suddenly lunged at another dog in the condominium. The pull of the leash twisted his finger forcefully, creating a torsion mechanism on the proximal phalanx capable of fracturing the bone even without a visually dramatic trauma. To avoid this type of injury, it's best to hold the leash firmly, without wrapping it around the fingers, and to stay especially alert in environments with other animals.
The diagnosis
Torsion fractures like this one are often subtle on initial X-rays. In Rafael's case, the injury appeared to have practically no displacement, even to the orthopedist who treated him in the emergency room, but there was already a slight displacement, difficult to notice without a specific evaluation by a hand surgery specialist.
Rafael was placed in a splint and advised to continue outpatient follow-up. The problem is that, without early follow-up with a hand surgeon, this small initial displacement progressed over the following weeks, and the fracture ended up healing out of its ideal position. By the time he finally reached the specialized consultation, three weeks after the trauma, the situation had changed: when closing his hand, Rafael showed a significant rotational deviation, with one finger crossing over the other, which would compromise physical activities, work, and even simple tasks like handling objects or playing musical instruments.
The treatment
If identified soon after the trauma, this initial deviation could probably have been corrected conservatively, still in the office, without the need for surgery. However, since the fracture had already consolidated for three weeks, a larger procedure was necessary: "refreshing" the fracture, a term used by Prof. José Mauricio Carmo, one of the pioneers of hand surgery in Brazil, meaning redoing the fracture site in a controlled way to allow for correct new alignment. Rafael was operated on the day after the consultation.
The surgery
The team opted for fixation with an intramedullary screw, a technique that has been gaining ground as an alternative to the traditional Kirschner wire because it allows earlier mobilization and better functional outcomes. In general, this type of implant does not, by itself, correct rotational deviation. In this case, however, the available screw had a diameter exactly compatible with the medullary canal of Rafael's proximal phalanx, fitting so snugly within the bone that it prevented the fragment from rotating around its own axis, thereby also controlling the rotational deviation in addition to stabilizing the fracture.
Preoperative
Postoperative
Recovery
This stability allowed active mobilization of the finger to begin on the very first postoperative day, reducing the risk of joint stiffness and scar adhesions.
After the surgery, Rafael regained proper alignment of the finger, with adequate bone healing and no signs of rotational deviation.
What this case teaches
This case reinforces two important points. The first is about care when handling pets: holding the leash correctly can prevent serious injuries, even in situations that seem trivial. The second is about the time between trauma and specialized evaluation: hand fractures, even when subtle on initial X-rays, can hide deviations that progress without proper follow-up. The sooner a specialist evaluates the injury, the greater the chances of simpler treatment, and the better the chances of preserving hand function for work, sports, and even for playing an instrument.
— Dr. Rodrigo Berlink e Dr. André Eiras
If you ever need a second opinion, or know a friend who needs a specialized evaluation, visit riohandexperts.com.br and schedule a consultation. Our offices are located in different neighborhoods of Rio de Janeiro.
