Finger (phalanx) fracture: Difference between revisions

Latest revision as of 22:43, 22 March 2023

Background

Be wary of avulsion fracture of base of phalanx
- Lateral or medial fracture fragment = collateral ligament avulsion
- Dorsal fracture fragment = extensor tendon avulsion
- Palmar fracture fragment = volar plate avulsion

Finger (phalanx) fracture types

Clinical Features

Unnatural angulation of a phalanx fracture.

Pain and/or swelling of the digit

Differential Diagnosis

Hand and Finger Fracture Types

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

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-* Be wary of avulsion fx of base of phalanx
+*Be wary of avulsion fracture of base of phalanx
-** Lateral or medial fracture fragment = collateral ligament avulsion
+**Lateral or medial fracture fragment = collateral ligament avulsion
-** Dorsal fracture fragment = extensor tendon avulsion
+**Dorsal fracture fragment = extensor tendon avulsion
-** Palmar fracture fragment = volar plate avulsion
+**Palmar fracture fragment = volar plate avulsion
-* Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture
-==Proximal Phalanx Fracture==
+{{Finger fracture types}}
-===Examination===
-* Examine the phalanx with the fingers in full extension and flexion
-* Assess for malrotation
-===Imaging===
+==Clinical Features==
-* AP, lateral, oblique
+[[File:Broken finger.jpg|thumb|Unnatural angulation of a phalanx fracture.]]
-** Examine for rotation, shortening, angulation
+*Pain and/or swelling of the digit
-===Treatment===
+==Differential Diagnosis==
-* If requires ortho referral: Radial or ulnar gutter splint
+{{Hand and finger fractures DDX}}
-* 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
-* Displaced or angulated fx
-** Consider closed reduction
-*** After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)
-===Disposition===
+==Management==
-* Refer for:
+{{General Fracture Management}}
-** Intraarticular
-** Unstable
-*** Spiral or oblique fx
-*** Condylar fx
-*** Neck fx
-*** Large avulsion fx
-** Rotated
-*** NO degree of rotation is acceptable following a reduction
-** Shortened
-** Significantly angulated
-*** Less than 10 degrees may be tolerated
-==Middle Phalanx Fracture==
-* Commonly associated with tendon injuries!
-===Examination===
-* Assess PIP, DIP flexion/extension
-* Assess PIP, DIP collateral ligaments (varus/valgus stress)
-===Images===
-* AP, lateral, oblique
-* Oblique and spiral fractures: evaluate for shortening/malrotation
-===Treatment===
-* 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 fx
-** Closed reduction
-*** Adequate reduction:
-**** <1-2mm displacement or shortening
-**** Up to 10 degrees of angulation
-**** No amount rotation
-*** Followed by ulnar 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
-===Dispo===
-* Refer for:
-** Comminution
-** Malrotation
-** Intraarticular fx
-** Displaced or angulated fractures that cannot maintain their reduction
-** Most spiral and oblique fx (usually involve rotation or shortening and are unstable)
-==Distal Phalanx Fx==
-===Examination===
-* Evaluate for tendon damage
-===Imaging===
-* Comminuted tuft fx
-** Stable
-* Longitudinal fx
-** Usually non-displaced and stable
-* Transverse fx
-** Evaluate for angulation/displacement
-* Intraarticular fx
-===Treatment===
-* Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
-** Do not attempt to reduce comminuted tuft fx
-===Dispo===
-* Refer for:
-** Tendon dysfunction
-** Nerve dysfunction
-** Displacement or angulation
-** Intraarticular fx
 ==See Also==
-*[[Fractures (Main)]]
+*[[Hand and Finger Fractures]]
 *[[Hand Diagnoses (Main)]]
-==Source==
+==References==
-UpToDate
+<References/>
-[[Category:Ortho]]
+[[Category:Orthopedics]]