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| ===Pearls=== | | ==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 |
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| * Be wary of avulsion fx of base of phalanx
| | {{Finger fracture types}} |
| ** Lateral or medial fracture fragment = collateral ligament avulsion
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| ** Dorsal fracture fragment = extensor tendon avulsion
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| ** Palmar fracture fragment = volar plate avulsion
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| * Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture�
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| ====== | | ==Clinical Features== |
| | [[File:Broken finger.jpg|thumb|Unnatural angulation of a phalanx fracture.]] |
| | *Pain and/or swelling of the digit |
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| ===Proximal Phalanx Fx=== | | ==Differential Diagnosis== |
| | {{Hand and finger fractures DDX}} |
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| * Examination
| | ==Management== |
| ** Examine the phalanx with the fingers in full extension and flexion
| | {{General Fracture Management}} |
| ** Assess for malrotation
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| * Imaging
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| ** AP, lateral, oblique
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| *** Examine for rotation, shortening, angulation
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| * Treatment
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| ** If requires ortho referral: Radial or ulnar gutter splint
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| ** Nondisplaced, stable:� Consider buddy taping the injured finger to an adjacent finger
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| *** If the ring finger is involved it should be buddy taped to the little finger
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| ** Displaced or angulated fx
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| *** Consider closed reduction
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| **** After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)�
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| * Disposition
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| ** Refer for:
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| *** Intraarticular
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| *** Unstable
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| **** Spiral or oblique fx
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| **** Condylar fx
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| **** Neck fx
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| **** Large avulsion fx
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| *** Rotated
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| **** NO degree of rotation is acceptable following a reduction
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| *** Shortened
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| *** Significantly angulated
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| **** Less than 10� may be tolerated
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| ===Middle Phalanx Fx=== | | ==See Also== |
| | *[[Hand and Finger Fractures]] |
| | *[[Hand Diagnoses (Main)]] |
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| * Commonly associated with tendon injuries!
| | ==References== |
| * Examination
| | <References/> |
| ** Assess PIP, DIP flexion/extension
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| ** Assess PIP, DIP collateral ligaments (varus/valgus stress)
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| * Images
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| ** AP, lateral, oblique
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| ** Oblique and spiral fractures: evaluate for shortening/malrotation
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| * Treatment
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| ** Nondisplaced without angulation:
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| *** Buddy tape to adjacent finger
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| **** Buddy tape ring finger to little finger
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| *** Dorsal or volar finger splint if desire added protection�
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| ** Displaced or angulated fx
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| *** Closed reduction
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| **** Adequate reduction:
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| ***** <1-2mm displacement or shortening
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| ***** Up to 10� of angulation
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| ***** No amount rotation
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| **** Followed by ulnar or radial gutter splint
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| ***** Wrist in 20-30� of extension
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| ***** MCP joints in 70-90� of flexion
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| ***** PIP and DIP joints flexed 5-10�
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| ****** Decreases the force exerted by the FDS�
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| * Dispo
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| ** Refer for:
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| *** Comminution
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| *** Malrotation
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| *** Intraarticular fx
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| *** Displaced or angulated fractures that cannot maintain their reduction
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| *** Most spiral and oblique fx (usually involve rotation or shortening and are unstable)
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| ===Distal Phalanx Fx===
| | [[Category:Orthopedics]] |
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| * Examination
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| ** Evaluate for tendon damage
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| * Imaging
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| ** Comminuted tuft fx
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| *** Stable
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| ** Longitudinal fx
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| *** Usually non-displaced and stable
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| ** Transverse fx
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| *** Evaluate for angulation/displacement
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| ** Intraarticular fx
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| * Treatment
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| ** Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx(
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| *** Do not attempt to reduce comminuted tuft fx�
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| * Dispo
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| ** Refer for:
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| *** Tendon dysfunction
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| *** Nerve dysfunction
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| *** Displacement or angulation
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| *** Intraarticular fx
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| ==Source==
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| UpToDate
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| [[Category:Ortho]] | |
