Distal phalanx (finger) fracture: Difference between revisions
| Line 28: | Line 28: | ||
==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Specific Management=== | |||
*Nonoperative | *Nonoperative | ||
**Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx | **Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx | ||
| Line 33: | Line 36: | ||
**Eval nail bed | **Eval nail bed | ||
***Is a [[Nailbed laceration]] underneath possible? | ***Is a [[Nailbed laceration]] underneath possible? | ||
**Digital | **[[Digital block]]s can be helpful for evaluation and management | ||
**Do not attempt to reduce comminuted tuft fracture | **Do not attempt to reduce comminuted tuft fracture | ||
*Call Hand or Ortho (institution dependent) for complex finger injuries | *Call Hand or Ortho (institution dependent) for complex finger injuries | ||
Revision as of 02:59, 18 September 2019
Background
- Fracture of distal portion of distal phalanx is also known as a "Tuft fracture"
- Hand: finger slammed in door
- Foot: stubbed toe or dropped a heavy object
Clinical Features
- Pain and/or swelling of the digit
- Sensation usually intact
- Pain on palpation
Differential Diagnosis
Distal Finger (Including Nail) Injury
- Distal interphalangeal dislocation (finger)
- Distal phalanx (finger) fracture
- Finger amputation
- Fingertip avulsion
- Finger infection
- Nailbed laceration
- Nail avulsion
- Subungual hematoma
Hand and Finger Fracture Types
Examination
- Evaluate for tendon damage
- Always look for a second fracture
Imaging
- Hand Xrays to rule out additional fractures
- Comminuted tuft fracture
- Stable
- Longitudinal fracture
- Usually non-displaced and stable
- Transverse fracture
- Evaluate for angulation/displacement
- Intraarticular fracture
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
Specific Management
- Nonoperative
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
- Most cases
- Eval nail bed
- Is a Nailbed laceration underneath possible?
- Digital blocks can be helpful for evaluation and management
- Do not attempt to reduce comminuted tuft fracture
- Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
- Call Hand or Ortho (institution dependent) for complex finger injuries
- Nailbed laceration with distal phalanx fractures can be complicated and result in an open fracture
Prophylactic Antibiotics
Prophylactic antibiotics are NOT indicated despite open phalangeal finger fracture if:
- Fractures is metacarpophalangeal joint (i.e. Tuft fracture)
- Intact digital arteries
Disposition
- Refer for:
- Tendon dysfunction
- Nerve dysfunction
- Displacement or angulation
- Intraarticular fracture
- Complex involving Nailbed laceration