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Graeme Smith, the South Africa cricket captain, sustained a fracture to the fourth finger of his left hand that could put him out of the upcoming home Test series against India. Smith sustained the injury when he was hit by a Shoaib Akhtar bouncer. Smith broke his right middle finger during the 2010 Indian Premier League, while a fractured little finger on his left hand kept him out of the recent series in India in February. Mitchell Johnson broke Smith’s right hand twice during South Africa’s home and away series against Australia in 2008–09.

Compiled from ESPN Cricinfo (, November 2010


Sport-related injuries account for up to 15% of all hand injuries seen in accident and emergency departments.1 Although the majority of hand and finger injuries require minimal treatment, some are potentially serious and require immobilization, precise splinting, or even surgery. Finger injuries are often neglected by sportspeople with the expectation that they will resolve spontaneously. This means that the patient often presents too late for effective treatment. The importance of early assessment and management must be stressed so that long-term deformity and functional impairment can be avoided. Many hand and finger injuries require specific rehabilitation and appropriate protection on resumption of sport. Joints in this region do not respond well to immobilization; therefore, full immobilization should be minimized. The causes of pain in this region are shown in Table 24.1.

Table Graphic Jump Location
Table 24.1

Causes of hand and finger pain


The anatomy of this area is demonstrated in Figure 24.1).

Figure 24.1

Anatomy of the metacarpals and fingers

(a) Metacarpals and fingers

Graphic Jump Location

Clinical evaluation




The mechanism of injury is the most important component of the history of acute hand injuries. A direct, severe blow to the fingers may result in a fracture, whereas a blow to the point of the finger may produce an interphalangeal dislocation, joint sprain, or long flexor or extensor tendon avulsion. A punching injury often results in a fracture at the base of the first ...

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