Middle phalanx (finger) fracture

Background

• Commonly associated with tendon injuries!

Finger (phalanx) fracture types

• Proximal Phalanx (Finger) Fracture
• Middle Phalanx (Finger) Fracture
• Distal Phalanx (Finger) Fracture

Clinical Features

• Pain and/or swelling of the digit

Examination

• Assess PIP, DIP flexion/extension
• Assess PIP, DIP collateral ligaments (varus/valgus stress)

Differential Diagnosis

Hand and Finger Fracture Types

• Non-thumb metacarpal fractures
  • Head
  • Neck
  • Shaft
  • Base
  • Boxer's fracture
• Thumb fracture
• Finger (Phalanx) Fracture
  • Proximal
  • Middle
  • Distal

Evaluation

Workup

• AP, lateral, oblique finger x-ray
• Oblique and spiral fractures: evaluate for shortening/malrotation

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

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 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

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