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Injuries and Medical Advice

Finger Injury: Fusion or Amputation

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I subscribe to Rock and Ice since you have access to medical professionals who can help climbers like me. Three weeks ago, while I was driving in Caracas, two motorcyclists tried to steal my iPhone and shot me. Fortunately, the shot was only in my right hand. I did lose the metacarpal joint of the ring finger. I started physiotherapy one week ago. At this moment I am not able to move my little or ring fingers, both joints are very rigid, and I am afraid that I might not rock climb again. How can I regain the use of my fingers?

— Ignacio Juaristi, Caracas, Venezuela


It could have been worse, but that finger is in a bad place, and I’m not sure it’s going to get much better in the medium term.

You really only have two long-term options— fusion or amputation. Still, let me give you a few landmarks so you can get a sense of where you are and where this might go.

Tendons must be reconnected within 10 days or the procedure becomes substantially more complicated due to tendon retraction. Nerves need to be reconnected within two weeks or the likelihood of them regenerating is virtually neutered. You are beyond these windows of opportunity.

If you do nothing, the “fuse it” option will occur on its own by way of a false joint called a pseudarthrosis. Your capacity to move the joint will be somewhere between nothing and a smidgeon more than nothing. The problem is that your comfort level will be somewhere between mild ongoing pain and, “If I were my dog I’d give me the green dream.”

An orthopedic friend who has a doctorate in medical engineering, and who climbs mid 5.12s off the couch, advises that the wound be opened and cleaned multiple times in the coming weeks, the joints fused with a plate. A fusion in 30-40 degrees of flexion would probably work well all around. This would allow you to concentrate on rehabilitating the injured pinky.

The second option—amputation—is not urgent. If the above doesn’t work, then ditching the finger will still be an option.The gap created between the middle and pinky fingers would diminish over time and you’d have three functioning fingers.

Ignacio, people climb with no fingers. One climber missing all the fingers on one hand free soloed many hard routes, including the Diving Board, a wildly exposed four-pitch 5.11 with a hand/fist/offwidth, in Eldo. This guy was careful to select routes where footwork compensated for the lack of fingers, or he picked hand and larger cracks where he could jam what he had of a hand. You still have a lifetime of great climbing ahead of you.

Feature image by Boone Speed

This article appeared in Rock and Ice 236

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