Case Study: Acute Fifth Digit Injury in an Uninsured Patient with Delayed Presentation

Case at a Glance

A 34-year-old uninsured male sustained an injury to his fifth digit after a fall, leading to significant pain and swelling. He hesitated to seek immediate medical care due to financial constraints, weighing the cost of an urgent care visit against the potential for long-term functional impairment.

Patient's Story

The patient is a 34-year-old male, currently between jobs and without health insurance, who presented with an acute injury to his right hand. He reported falling earlier in the day and landing awkwardly on his hand. Immediately following the incident, he experienced significant pain and noticeable swelling in his right fifth digit (pinky finger). He had no prior history of fractures. The patient was concerned about the potential severity of the injury but was reluctant to seek care due to the anticipated out-of-pocket cost of an urgent care visit and diagnostic imaging.

Initial Assessment

The patient's chief complaint was severe pain and swelling of the right fifth digit, with a marked inability to flex the finger without exacerbating the pain. He expressed anxiety about the cost of treatment, asking if it was safe to 'wait and see' for a few days. He also inquired about the risk of complications such as infection. The initial dilemma for the patient was whether the potential for a permanent deformity or loss of function—such as chronic stiffness—outweighed the immediate financial burden of seeking a diagnosis.

The Diagnostic Journey

The patient's decision to seek care was influenced by advice considering the 'worst-case scenario' of living with a stiff and non-functional finger. Recognizing that a delayed diagnosis could lead to a poor long-term outcome, he presented to an urgent care clinic for evaluation. A physical examination revealed significant edema, ecchymosis, and point tenderness over the proximal phalanx of the fifth digit. There was no open wound, and neurovascular function was intact. Given the clinical suspicion of a fracture, an X-ray of the right hand was ordered to confirm the diagnosis.

Final Diagnosis

Non-displaced fracture of the proximal phalanx of the right fifth digit.

Treatment Plan

Based on the stable, non-displaced nature of the fracture, a conservative management plan was initiated. The injured fifth digit was buddy-taped to the fourth digit (ring finger) to provide splinting and support while allowing for controlled movement of the metacarpophalangeal joint. The patient was instructed to follow the RICE protocol (Rest, Ice, Compression, Elevation) for the first 48-72 hours to manage swelling. Over-the-counter NSAIDs were recommended for analgesia. He was counseled on the importance of beginning gentle range-of-motion exercises after the initial acute phase to prevent joint stiffness.

Outcome and Follow-up

The patient adhered to the conservative treatment plan. At a 4-week follow-up, his pain and swelling had substantially decreased. He demonstrated a good functional recovery with a near-complete range of motion and minimal residual stiffness. This case highlights a common challenge where financial barriers can cause significant delays in seeking care, posing a risk for complications that, in this instance, were fortunately avoided.