In this episode of The Good GP, host Dr Tim Koh is joined by Dr Jeff Ecker, an orthopaedic surgeon with over 35 years of experience specialising in complex hand and wrist conditions. Focusing on the assessment and management of finger fractures, an injury commonly encountered by general practitioners, but often associated with diagnostic dilemmas and management challenges.

Dr Ecker highlights the potential seriousness of finger fractures, noting that even minor injuries can result in permanent impairment, significant hand dysfunction, and long-term complications if not managed appropriately. Discussing the importance of maintaining a high index of suspicion with finger injuries, recognising that early recognition and appropriate follow-up are essential to achieving optimal outcomes.

Providing the typical types of finger fractures and their clinical features. Subungual hematoma and associated terminal phalanx fractures. Mallet finger deformities (with and without fractures). PIP (proximal interphalangeal) joint injuries and their complications, such as boutonniere and swan neck deformities. Along with less common injuries around the MCP (metacarpophalangeal) joint

Dr Ecker provides practical tips for clinical assessment, stressing the importance of plain X-rays in all suspected cases, and the utility of CT scans or ultrasound if there is diagnostic uncertainty or persistent symptoms. He also addresses when to refer to a specialist, focusing on signs of instability, articular involvement, or tendon injury.

The episode concludes with practical advice on materials and techniques for conservative fracture management, with an emphasis on working closely with qualified hand therapists and prioritising early functional use.

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