Middle phalanx (finger) fracture

Background

  • 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

Differential Diagnosis

Hand and Finger Fractures

Management

  • Nondisplaced without angulation:
  • Displaced or angulated fracture
    • Closed reduction
      • Adequate reduction:
        • <1-2mm displacement or shortening
        • Up to 10 degrees of angulation
        • No amount rotation
      • Followed by Ulnar Gutter Splint 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

Disposition

  • Refer for:
    • Comminution
    • Malrotation
    • Intraarticular fracture
    • Displaced or angulated fractures that cannot maintain their reduction
    • Most spiral and oblique fracture (usually involve rotation or shortening and are unstable)

See Also

References

UpToDate