Open Finger Fracture (Child)

Your child has a broken (fractured) finger. With an open fracture, a broken bone is exposed by a break in the skin. Because of this, there is a risk for infection to the skin or bone. An open fracture will be painful, swollen, and bruised. It may also be bloody.

To confirm the extent of the fracture, X-rays or other imaging tests are usually done. The bone may then be moved back into place. The skin wound may then be closed, possibly with stitches or surgical skin glue. To protect the injured finger and hold the bone in place while it heals, the finger or hand may be put into a splint or cast. Or the injured finger may be taped to the finger beside it. (This is called “buddy taping.”) If the fingernail has been significantly injured, it may be removed surgically. Or it will be left to fall off, often in 1 to 2 weeks. A new fingernail will likely start to grow back within a month.

Your child may need surgery if the fracture is severe. This is done by an orthopedic surgeon. This is a surgeon who specializes in treating bone, muscle, joint, and tendon problems.

Depending on the cause of the injury and your child’s vaccine status, they may get a tetanus shot.

Home care

  • The healthcare provider may prescribe an oral antibiotic to prevent infection. Follow instructions for giving this medicine to your child. Don't stop giving your child this medicine until you have finished the prescribed course.

  • Give your child pain medicines as directed by the healthcare provider. Don't give your child aspirin unless told to by a healthcare provider.

  • Keep the child's hand elevated to reduce pain and swelling. This is most important during the first 48 hours after injury. As often as possible, have the child sit or lie down and place pillows under the child’s hand until it's raised above the level of the heart. For babies and toddlers, lay the child down and place pillows under the hand until the injury is raised above the level of the heart. Be sure the pillows don't move near the face of the baby or toddler. Never leave the child unsupervised.

  • Put a cold pack on the injury to help control swelling. You can make a cold pack by wrapping a plastic bag of ice cubes in a thin towel. As the ice melts, be careful that the cast or splint doesn’t get wet. Don't put the ice directly on the skin, because this can cause damage. You can place a cold pack directly over a splint or cast.

  • Ice the injured area for up to 20 minutes every 1 to 2 hours the first day. Continue this 3 to 4 times a day for the next 2 days, then as needed. It may help to make a game of using the ice. But don't force your child to use the ice. 

  • Care for the splint or cast as you’ve been instructed. Don’t put any powders or lotions inside the splint or cast. Keep your child from sticking objects into the splint or cast.

  • Keep the splint or cast completely dry at all times. The splint or cast should be covered with a plastic bag and kept out of the water when your child bathes. Close the top end of the bag with tape or rubber bands.

  • If buddy tape becomes wet or dirty, change it. You can replace it with paper, plastic, or cloth tape. Cloth tape and paper tape must be kept dry. Keep the buddy tape in place, as directed by the child's healthcare provider.

Follow-up care

Follow up with the child's healthcare provider, or as advised. Follow-up X-rays may be needed to see how the bone is healing. If your child was given a splint, it may be changed to a cast at the follow-up visit. If you were referred to a specialist, make that appointment right away.

Special note to parents

Healthcare providers are trained to recognize injuries like this one in young children as a sign of possible abuse. Several healthcare providers may ask questions about how your child was injured. Healthcare providers are required by law to ask you these questions. This is done for protection of the child. Please try to be patient and not take offense.

When to seek medical advice

Call your child's healthcare provider if any of these occur:

  • Wet or soft splint or cast

  • Splint or cast is too tight. Loosen a splint before calling for help.

  • Increasing swelling or pain after a cast or splint is put on the hand. Babies who can't yet talk may show pain with crying that can't be soothed.

  • Injured finger, nearby fingers, or the hand becomes cold, blue, numb, burning, or tingly

  • Redness, warmth, swelling, or drainage from the wound, or foul odor from a cast or splint

  • In babies: Fussiness or crying that can't be soothed

  • Fever (see Fever and children, below) or chills

Call 911

Call 911 if your child has:

  • Trouble breathing

  • Confusion

  • Trouble awakening or is very drowsy

  • Fainting or loss of consciousness

  • Rapid heart rate

  • Seizure

  • Stiff neck

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4 or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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