Distal phalanx (finger) fracture

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Background

  • Fracture of distal portion of distal phalanx is also known as a "Tuft fracture"
  • Hand: finger slammed in door
  • Foot: stubbed toe or dropped a heavy object

Clinical Features

  • Pain and/or swelling of the digit
  • Sensation usually intact
    • Pain on palpation

Differential Diagnosis

Hand and Finger Fractures

Examination

  • Evaluate for tendon damage
  • Always look for a second fracture

Imaging

  • Hand Xrays to rule out additional fractures
  • Comminuted tuft fracture
    Error creating thumbnail: File missing
    Tuft's fracture
    • Stable
  • Longitudinal fracture
    • Usually non-displaced and stable
  • Transverse fracture
    • Evaluate for angulation/displacement
  • Intraarticular fracture

Management

  • Nonoperative
    • Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
      • Most cases
    • Eval nail bed
    • Digital blocks can be helpful for evaluation and management
    • Do not attempt to reduce comminuted tuft fracture
  • Call Hand or Ortho (institution dependent) for complex finger injuries
    • Nailbed laceration with distal phalanx fractures can be complicated and result in open fractures

Disposition

  • Refer for:
    • Tendon dysfunction
    • Nerve dysfunction
    • Displacement or angulation
    • Intraarticular fracture
    • Complex involving Nailbed laceration

See Also

References