Middle phalanx (finger) 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)

See Also

• Finger (Phalanx) Fracture
• Hand Diagnoses (Main)

Source

UpToDate