Finger (phalanx) fracture: Difference between revisions

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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


==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]]


===Imaging===
==Differential Diagnosis==
* AP, lateral, oblique
{{Hand and finger fractures DDX}}
** Examine for rotation, shortening, angulation


===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
** 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


==See Also==
==See Also==
[[Subungual Hematoma]]
*[[Hand and Finger Fractures]]
*[[Hand Diagnoses (Main)]]


==Source==
==References==
UpToDate
<References/>


[[Category:Ortho]]
[[Category:Orthopedics]]

Revision as of 02:56, 18 September 2019

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

Types

Differential Diagnosis

Hand and Finger Fracture Types

Management

General Fracture Management

See Also

References