Middle phalanx (finger) fracture: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Pain and/or swelling of the digit | *Pain and/or swelling of the digit | ||
===[[Hand exam|Examination]]=== | ===[[Hand exam|Examination]]=== | ||
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{{Hand and finger fractures DDX}} | {{Hand and finger fractures DDX}} | ||
==Evaluation | ==Evaluation== | ||
===Workup=== | ===Workup=== | ||
*AP, lateral, oblique finger x-ray | *AP, lateral, oblique finger x-ray | ||
Latest revision as of 22:42, 22 March 2023
Background
- Commonly associated with tendon injuries!
Finger (phalanx) fracture types
- Proximal Phalanx (Finger) Fracture
- Middle Phalanx (Finger) Fracture
- Distal Phalanx (Finger) Fracture
Clinical Features
- Pain and/or swelling of the digit
Examination
- Assess PIP, DIP flexion/extension
- Assess PIP, DIP collateral ligaments (varus/valgus stress)
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
Workup
- AP, lateral, oblique finger x-ray
- Oblique and spiral fractures: evaluate for shortening/malrotation
Diagnosis
Management
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Nondisplaced without angulation
- Buddy tape to adjacent finger
- Buddy tape ring finger to little finger
- Dorsal or volar Finger Splint if desire added protection
Displaced or angulated fracture
- Closed reduction
- Adequate reduction:
- <1-2mm displacement or shortening
- Up to 10 degrees of angulation
- No amount rotation
- Followed by Ulnar Gutter Splint or Radial Gutter Splint
- Wrist in 20-30 degrees of extension
- MCP joints in 70-90 degrees of flexion
- PIP and DIP joints flexed 5-10 degrees
- Decreases the force exerted by the FDS
- Adequate reduction:
Disposition
- Refer for:
- Comminution
- Malrotation
- Intraarticular fracture
- Displaced or angulated fractures that cannot maintain their reduction
- Most spiral and oblique fracture (usually involve rotation or shortening and are unstable)