Middle phalanx (finger) fracture: Difference between revisions
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==Background== | ==Background== | ||
* Commonly associated with tendon injuries! | *Commonly associated with tendon injuries! | ||
{{Finger fracture types}} | |||
== | ==Clinical Features== | ||
* | *Pain and/or swelling of the digit | ||
== | ===[[Hand exam|Examination]]=== | ||
* Nondisplaced without angulation | *Assess PIP, DIP flexion/extension | ||
*Assess PIP, DIP collateral ligaments (varus/valgus stress) | |||
==Differential Diagnosis== | |||
{{Hand and finger fractures DDX}} | |||
==Evaluation== | |||
===Workup=== | |||
*AP, lateral, oblique finger x-ray | |||
*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== | ==Disposition== | ||
* Refer for: | *Refer for: | ||
** Comminution | **Comminution | ||
** Malrotation | **Malrotation | ||
** Intraarticular | **Intraarticular fracture | ||
** Displaced or angulated fractures that cannot maintain their reduction | **Displaced or angulated fractures that cannot maintain their reduction | ||
** Most spiral and oblique | **Most spiral and oblique fracture (usually involve rotation or shortening and are unstable) | ||
==See Also== | ==See Also== | ||
| Line 39: | Line 53: | ||
*[[Hand Diagnoses (Main)]] | *[[Hand Diagnoses (Main)]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Orthopedics]] | ||
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)