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| ==Background== | | ==Background== |
| * Be wary of avulsion fx of base of phalanx | | *Be wary of avulsion fracture of base of phalanx |
| ** Lateral or medial fracture fragment = collateral ligament avulsion | | **Lateral or medial fracture fragment = collateral ligament avulsion |
| ** Dorsal fracture fragment = extensor tendon avulsion | | **Dorsal fracture fragment = extensor tendon avulsion |
| ** Palmar fracture fragment = volar plate avulsion | | **Palmar fracture fragment = volar plate avulsion |
| * Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture
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| ==Proximal Phalanx Fracture== | | ==Types== |
| ===Examination===
| | *[[Proximal Phalanx (Finger) Fracture]] |
| * Examine the phalanx with the fingers in full extension and flexion | | *[[Middle Phalanx (Finger) Fracture]] |
| * Assess for malrotation | | *[[Distal Phalanx (Finger) Fracture]] |
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| ===Imaging=== | | ==Differential Diagnosis== |
| * AP, lateral, oblique
| | {{Hand and finger fractures DDX}} |
| ** Examine for rotation, shortening, angulation
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| ===Treatment=== | | ==Management== |
| * If requires ortho referral: Radial or ulnar gutter splint
| | {{General Fracture Management}} |
| * 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 degrees may be tolerated
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| ==Middle Phalanx Fracture==
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| * Commonly associated with tendon injuries!
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| ===Examination===
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| * 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 degrees 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 degrees of extension
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| **** MCP joints in 70-90 degrees of flexion
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| **** PIP and DIP joints flexed 5-10 degrees
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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==
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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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| ==See Also== | | ==See Also== |
| [[Subungual Hematoma]] | | *[[Hand and Finger Fractures]] |
| | *[[Hand Diagnoses (Main)]] |
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| ==Source== | | ==References== |
| UpToDate
| | <References/> |
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| [[Category:Ortho]] | | [[Category:Orthopedics]] |