Proximal phalanx (finger) fracture: Difference between revisions
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==Background== | ==Background== | ||
*The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | |||
*Extensor tendons and interosseous muscles commonly causes volar angulation<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | |||
{{Finger fracture types}} | |||
== | ==Clinical Features== | ||
* | *Pain and/or swelling of the digit | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hand and finger fractures DDX}} | {{Hand and finger fractures DDX}} | ||
== | ==Evaluation== | ||
* | ===Physical=== | ||
* Nondisplaced, stable | *Examine the phalanx with the fingers in full extension and flexion | ||
** If the ring finger is involved it should be [[buddy taped]] to the little finger | *Assess for malrotation | ||
* Displaced or angulated | |||
===Imaging=== | |||
*AP, lateral, oblique | |||
**Examine for rotation, shortening, angulation | |||
==Management== | |||
{{General Fracture Management}} | |||
===Nondisplaced, stable=== | |||
*Consider [[buddy taping]] the injured finger to an adjacent finger | |||
**If the ring finger is involved it should be [[buddy taped]] to the little finger | |||
**Dorsal or volar [[Finger Splint]] if desire added protection | |||
===Displaced or angulated fracture=== | |||
*Consider closed reduction | |||
**After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture) | |||
===Immobilization=== | |||
*If requires ortho referral: [[Radial gutter splint]] or [[ulnar gutter splint]]<ref name="Hand and wrist emergencies">German C. Hand and wrist emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | |||
==Disposition== | ==Disposition== | ||
* Refer for: | *Refer for: | ||
** Intraarticular | **Intraarticular | ||
** Unstable | **Unstable | ||
*** Spiral or oblique | ***Spiral or oblique fracture | ||
*** Condylar | ***Condylar fracture | ||
*** Neck | ***Neck fracture | ||
*** Large avulsion | ***Large avulsion fracture | ||
** Rotated | **Rotated | ||
*** NO degree of rotation is acceptable following a reduction | ***NO degree of rotation is acceptable following a reduction | ||
** Shortened | **Shortened | ||
** Significantly angulated | **Significantly angulated | ||
*** Less than 10 degrees may be tolerated | ***Less than 10 degrees may be tolerated | ||
==See Also== | ==See Also== | ||
| Line 38: | Line 53: | ||
*[[Hand Diagnoses (Main)]] | *[[Hand Diagnoses (Main)]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 22:42, 22 March 2023
Background
- The flexor digitorum superficialis (FDS) inserts at the middle of the phalanx and can cause rotational deformity[1]
- Extensor tendons and interosseous muscles commonly causes volar angulation[1]
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
Differential Diagnosis
Hand and Finger Fracture Types
Evaluation
Physical
- Examine the phalanx with the fingers in full extension and flexion
- Assess for malrotation
Imaging
- AP, lateral, oblique
- Examine for rotation, shortening, angulation
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, stable
- Consider buddy taping the injured finger to an adjacent finger
- If the ring finger is involved it should be buddy taped to the little finger
- Dorsal or volar Finger Splint if desire added protection
Displaced or angulated fracture
- Consider closed reduction
- After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)
Immobilization
- If requires ortho referral: Radial gutter splint or ulnar gutter splint[1]
Disposition
- Refer for:
- Intraarticular
- Unstable
- Spiral or oblique fracture
- Condylar fracture
- Neck fracture
- Large avulsion fracture
- Rotated
- NO degree of rotation is acceptable following a reduction
- Shortened
- Significantly angulated
- Less than 10 degrees may be tolerated