Swelling timeline for broken fingers

starsknight

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Hi all,

I've tried some independent research on this, but I'm not finding much, so I'm hoping someone here might be able to help. If someone's fingers are badly broken (multiple fractures, massive damage to the joints and bones both, but no bones sticking through the skin), what's the timeline likely to look like in the hours afterwards in terms of swelling/any other complications? At what point do the fingers (and other parts of the hand) swell as much as they're going to, and at what rate does the swelling generally go down over time if the injury is left untreated?

I'm guessing this varies by individual and specific injury, but any general guidelines would be helpful. Links to any relevant sources/resources are also great, if you have them! Thanks!
 
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MaeZe

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Are you planning on having this person heal without treatment? Because that's not going to happen.

When you fracture finger joints the tendons do funny things.

Boutonniere Deformity

eMedicine: Broken finger symptoms
As time goes on, usually within the next 5-10 minutes, swelling and bruising of the finger will occur and the finger will become stiff to move. Swelling is not as specific as pain and may affect the adjacent fingers as well.
If the fracture is severe, bruising from released blood may be seen immediately.
Finally, if the swelling is excessive, numbness of the finger may occur because the nerves in the fingers are compressed.
Bruising can be delayed by a day or more when bleeding around the bone takes a while to spread to the surface.

I have seen minimal swelling with single fractured fingers but with multiple injuries the swelling will be severe.
 
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starsknight

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Thanks, MaeZe. No, the person will not heal without treatment--well, not properly. He'll get treatment eventually, but the effects of the injury will be permanent as a result of the long delay. I do assume swelling will eventually decrease even without treatment, but I don't know whether we're talking days or weeks. Main thing I'm wondering is whether there'd be any difference in the amount of swelling, say, 10 minutes later versus 30 minutes versus an hour versus 24 hours.
 

MaeZe

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There's only so much room in a finger to swell. Most of the swelling is fairly quick but not always.

It would be done swelling in 24-48 hours if it wasn't continuing to be injured and resolve mostly by about a week.

I'm not sure a reader is going to care if you wing-it.
 
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shadowsminder

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Based on my personal experiences and observations: that hand is immediately unusuable and will remain that way unless it receives treatment.

Someone who is incredibly stubborn and able to ignore the agonizing sensations might try to use it, but the fingers won't work. The pain will worsen. With functioning nerves, the pain can be overwhelming. The swelling is the worst part in regards to pain and danger. Hours without treatment? That's permanent damage. All that pain is a signal to the conscious mind to help the body.

When the injury is new, one risk is tissue death from lack of blood flow. I'm trying to remember the timeline for a former friend who played bloody knuckles with her sometimes lover and often enemy while they were both drunk. Sometime within a week, her swollen hand was black (like seared black) and bloodless white. She couldn't make a fist. She couldn't use the hand. That was despite icing the area that first night. (She did eventually heal without surgery and was able to keep her hand.)

I've never seen an injured hand go completely untreated, though. My guess is that by the swelling goes down on its own, that character would be dealing with more urgent medical issues--like a fatal blood clot. Large hematomas can and have created large clots that move through the body. How quickly that's an issue depends on the particular and what it's doing (as in resting or running around). Over-the-counter pain reducers tend to reduce that risk.

ETA: Hmmm. In 30 minutes, you could have more swelling than in 10 minutes. I've waited 20+ minutes to ice a mildly injured head before. The swelling was still building up.
 
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starsknight

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Thanks, both of you!

The main issue for me here is the timeline between, say, 10 minutes and 12 hours (so thanks, aspirit--knowing swelling is continuing to develop in that first 30 minutes is very helpful). The reason I'm wondering about specifics within the timeline is that I'm curious whether someone who'd seen a good number of injuries like this before would be able to make any assumptions about the time the injury was incurred based on swelling level. (Could you say, "Oh, that's probably been at least an hour?" "That probably happened at least a day ago?" Etc.)
 

jclarkdawe

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Bruising, swelling, healing, and clotting would all be used by a forensic specialist to determine the time of the injury. Of course, with a live patient, you simply ask them.

Jim Clark-Dawe
 

MaeZe

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Bruising has a timeline but it is not that specific. You can tell an old bruise from a new one. Old bruises turn yellow and green.

Broken bone bruising has some nuance but there is nothing consistently reliable except the fact you will get considerable bruising with broken bones.

The periosteum (lining around the bone) has a very rich blood supply and it tears when you break a bone. The trouble is, you might not see that significant bruise for days. Or, you might see it right away.

I had one of those Boutonniere fractures and it barely swelled at all. Right at the joint it was fat. I only went to the doctor because my finger looked funny.