Middle phalanx (finger) fracture: Difference between revisions

Latest revision as of 22:42, 22 March 2023

Background

Commonly associated with tendon injuries!

Finger (phalanx) fracture types

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

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)

References

Authors:

@@ Line 1: / Line 1: @@
-* Commonly associated with tendon injuries!
+==Background==
+*Commonly associated with tendon injuries!
-===Examination===
+{{Finger fracture types}}
-* Assess PIP, DIP flexion/extension
-* Assess PIP, DIP collateral ligaments (varus/valgus stress)
-===Images===
+==Clinical Features==
-* AP, lateral, oblique
+*Pain and/or swelling of the digit
-* Oblique and spiral fractures: evaluate for shortening/malrotation
-===Treatment===
+===[[Hand exam|Examination]]===
-* Nondisplaced without angulation:
+*Assess PIP, DIP flexion/extension
-** Buddy tape to adjacent finger
+*Assess PIP, DIP collateral ligaments (varus/valgus stress)
-*** 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===
+==Differential Diagnosis==
-* Refer for:
+{{Hand and finger fractures DDX}}
-** Comminution
-** Malrotation
+==Evaluation==
-** Intraarticular fx
+===Workup===
-** Displaced or angulated fractures that cannot maintain their reduction
+*AP, lateral, oblique finger x-ray
-** Most spiral and oblique fx (usually involve rotation or shortening and are unstable)
+*Oblique and spiral fractures: evaluate for shortening/malrotation
+===Diagnosis===
+==Management==
+{{General Fracture Management}}
+===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
+==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)
 ==See Also==
@@ Line 38: / Line 53: @@
 *[[Hand Diagnoses (Main)]]
-==Source==
+==References==
-UpToDate
+<references/>
-[[Category:Ortho]]
+[[Category:Orthopedics]]