Distal phalanx (finger) fracture: Difference between revisions

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==Background==
==Background==
*Fracture of distal portion of distal phalanx is also known as a "Tuft fracture"
*Hand: finger slammed in door
*Hand: finger slammed in door
*Foot: stubbed toe or dropped a heavy object
*Foot: stubbed toe or dropped a heavy object


==Clinical Presentation==
{{Finger fracture types}}
 
==Clinical Features==
*Pain and/or swelling of the digit
*Pain and/or swelling of the digit
*Sensation usually intact
*Sensation usually intact
**Pain on palpation
**Pain on palpation


===Examination===
==Differential Diagnosis==
*Evaluate for tendon damage
*[[Mallet finger]]
*Always look for the second fracture
{{DDX distal finger}}
{{Hand and finger fractures DDX}}
 
==Evaluation==
[[File:Tufts_fracture.jpg|thumb|Tuft's fracture]]
[[File:MalletFinger.png |thumb|Distal phalanx fracture concerning for [[Mallet finger]]]]


===Imaging===
===Imaging===
*Hand Xrays to rule out additional fractures
*Hand and/or finger x-rays
* Comminuted tuft fracture[[File:Tufts_fracture.jpg|thumb|Tuft's fracture]]
** Stable
* Longitudinal fracture
** Usually non-displaced and stable
* Transverse fracture
** Evaluate for angulation/displacement
* Intraarticular fracture


===Diagnosis===
*Comminuted tuft fracture
**Stable
*Longitudinal fracture
**Usually non-displaced and stable
*Transverse fracture
**Evaluate for angulation/displacement
*Intraarticular fracture
*Evaluate additionally for:
**Tendon damage
**Second fracture


==Differential Diagnosis==
==Management==
{{DDX distal finger}}


{{Hand and finger fractures DDX}}
===General Fracture Management===
*Acute pain management
*Open fractures (excluding distal phalanx fractures) require immediate IV antibiotics and urgent surgical washout
*Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention


==Treatment==
===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
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**Eval nail bed
**Eval nail bed
***Is a [[Nailbed laceration]] underneath possible?
***Is a [[Nailbed laceration]] underneath possible?
**Digital blocks can be helpful for evaluation and management
**[[Digital block]]s can be helpful for evaluation and management
**Do not attempt to reduce comminuted tuft fx
**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
**[[Nailbed laceration]] with distal phalanx fractures can be complicated and result in open fractures
**[[Nailbed laceration]] with distal phalanx fractures can be complicated and result in an [[open fracture]]
 
===Prophylactic Antibiotics===
Controversial but in general, prophylactic antibiotics are indicated for grossly contaminated open wounds, and can be considered in high risk patients (ex. diabetics, peripheral artery disease). Otherwise, NOT indicated in open distal phalanx fracture (aka tuft fracture) as long as:
*Fracture is at distal phalanx (i.e. tuft fracture)
*Intact digital arteries
*Clean wound


==Disposition==
==Disposition==
* Refer for:
*Refer for:
** Tendon dysfunction
**Tendon dysfunction
** Nerve dysfunction
**Nerve dysfunction
** Displacement or angulation
**Displacement or angulation
** Intraarticular fx
**Intraarticular fracture
**Complex involving [[Nailbed laceration]]
**Complex involving [[Nailbed laceration]]


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<references/>
<references/>


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

Latest revision as of 22:39, 22 March 2023

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

Finger (phalanx) fracture types

Clinical Features

  • Pain and/or swelling of the digit
  • Sensation usually intact
    • Pain on palpation

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and Finger Fracture Types

Evaluation

Tuft's fracture
Distal phalanx fracture concerning for Mallet finger

Imaging

  • Hand and/or finger x-rays

Diagnosis

  • Comminuted tuft fracture
    • Stable
  • Longitudinal fracture
    • Usually non-displaced and stable
  • Transverse fracture
    • Evaluate for angulation/displacement
  • Intraarticular fracture
  • Evaluate additionally for:
    • Tendon damage
    • Second fracture

Management

General Fracture Management

  • Acute pain management
  • Open fractures (excluding distal phalanx fractures) require immediate IV antibiotics and urgent surgical washout
  • Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention

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
    • Digital blocks can be helpful for evaluation and management
    • Do not attempt to reduce comminuted tuft fracture
  • Call Hand or Ortho (institution dependent) for complex finger injuries

Prophylactic Antibiotics

Controversial but in general, prophylactic antibiotics are indicated for grossly contaminated open wounds, and can be considered in high risk patients (ex. diabetics, peripheral artery disease). Otherwise, NOT indicated in open distal phalanx fracture (aka tuft fracture) as long as:

  • Fracture is at distal phalanx (i.e. tuft fracture)
  • Intact digital arteries
  • Clean wound

Disposition

  • Refer for:
    • Tendon dysfunction
    • Nerve dysfunction
    • Displacement or angulation
    • Intraarticular fracture
    • Complex involving Nailbed laceration

See Also

References

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