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 | ==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 | ||
==Differential Diagnosis== | |||
{{DDX distal finger}} | |||
{{Hand and finger fractures DDX}} | |||
==Examination== | ==Examination== | ||
*Evaluate for tendon damage | *Evaluate for tendon damage | ||
*Always look for | *Always look for a second fracture | ||
==Imaging== | ===Imaging=== | ||
*Hand Xrays to rule out additional fractures | *Hand Xrays to rule out additional fractures | ||
*Comminuted tuft fracture[[File:Tufts_fracture.jpg|thumb|Tuft's fracture]] | *Comminuted tuft fracture[[File:Tufts_fracture.jpg|thumb|Tuft's fracture]] | ||
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*Intraarticular fracture | *Intraarticular fracture | ||
== | ==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 | ||
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**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 | **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 | **[[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== | ==Disposition== | ||
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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 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