Finger (phalanx) fracture

Background

• Be wary of avulsion fx of base of phalanx
  • Lateral or medial fracture fragment = collateral ligament avulsion
  • Dorsal fracture fragment = extensor tendon avulsion
  • Palmar fracture fragment = volar plate avulsion
• Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture

Proximal Phalanx Fracture

Examination

• Examine the phalanx with the fingers in full extension and flexion
• Assess for malrotation

Imaging

• AP, lateral, oblique
  • Examine for rotation, shortening, angulation

Treatment

• If requires ortho referral: Radial or ulnar gutter splint
• 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

• Refer for:
  • 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

Source

UpToDate