Distal phalanx (finger) fracture: Difference between revisions
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*Sensation usually intact | *Sensation usually intact | ||
**Pain on palpation | **Pain on palpation | ||
==Differential Diagnosis== | |||
{{DDX distal finger}} | |||
{{Hand and finger fractures DDX}} | |||
==Examination== | ==Examination== | ||
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*Always look for the second fracture | *Always look for the second fracture | ||
==Imaging== | ===Imaging=== | ||
*Hand Xrays to rule out additional fractures | *Hand Xrays to rule out additional fractures | ||
*Comminuted tuft fracture[[File:Tufts_fracture.jpg|thumb|Tuft's fracture]] | *Comminuted tuft fracture[[File:Tufts_fracture.jpg|thumb|Tuft's fracture]] | ||
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**Evaluate for angulation/displacement | **Evaluate for angulation/displacement | ||
*Intraarticular fracture | *Intraarticular fracture | ||
==Management== | ==Management== | ||
Revision as of 17:01, 23 January 2017
Background
- Fracture of distal portion of distal phalanx is also known as a "Tuft fracture"
- Hand: finger slammed in door
- Foot: stubbed toe or dropped a heavy object
Clinical Features
- Pain and/or swelling of the digit
- Sensation usually intact
- Pain on palpation
Differential Diagnosis
Distal Finger (Including Nail) Injury
- Distal interphalangeal dislocation (finger)
- Distal phalanx (finger) fracture
- Finger amputation
- Fingertip avulsion
- Finger infection
- Nailbed laceration
- Nail avulsion
- Subungual hematoma
Hand and Finger Fracture Types
Examination
- Evaluate for tendon damage
- Always look for the second fracture
Imaging
- Hand Xrays to rule out additional fractures
- Comminuted tuft fracture
- Stable
- Longitudinal fracture
- Usually non-displaced and stable
- Transverse fracture
- Evaluate for angulation/displacement
- Intraarticular fracture
Management
- Nonoperative
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
- Most cases
- Eval nail bed
- Is a Nailbed laceration underneath possible?
- Digital blocks can be helpful for evaluation and management
- Do not attempt to reduce comminuted tuft fracture
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
- Call Hand or Ortho (institution dependent) for complex finger injuries
- Nailbed laceration with distal phalanx fractures can be complicated and result in open fractures
Disposition
- Refer for:
- Tendon dysfunction
- Nerve dysfunction
- Displacement or angulation
- Intraarticular fracture
- Complex involving Nailbed laceration