Distal phalanx (finger) fracture: Difference between revisions
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***Is a [[Nailbed laceration]] underneath possible? | ***Is a [[Nailbed laceration]] underneath possible? | ||
**Digital blocks can be helpful for evaluation and management | **Digital blocks can be helpful for evaluation and management | ||
**Do not attempt to reduce comminuted tuft | **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 open fractures | ||
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**Nerve dysfunction | **Nerve dysfunction | ||
**Displacement or angulation | **Displacement or angulation | ||
**Intraarticular | **Intraarticular fracture | ||
**Complex involving [[Nailbed laceration]] | **Complex involving [[Nailbed laceration]] | ||
Revision as of 10:41, 8 July 2016
Background
- Hand: finger slammed in door
- Foot: stubbed toe or dropped a heavy object
Clinical Presentation
- Pain and/or swelling of the digit
- Sensation usually intact
- Pain on palpation
Examination
- Evaluate for tendon damage
- Always look for the 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
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
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 open fractures
Disposition
- Refer for:
- Tendon dysfunction
- Nerve dysfunction
- Displacement or angulation
- Intraarticular fracture
- Complex involving Nailbed laceration