Distal phalanx (finger) fracture

Revision as of 02:59, 18 September 2019 by Rossdonaldson1 (talk | contribs) (Management)


  • 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

Hand and Finger Fractures


  • Evaluate for tendon damage
  • Always look for a second fracture


  • Hand Xrays to rule out additional fractures
  • Comminuted tuft fracture
    Tuft's fracture
    • Stable
  • Longitudinal fracture
    • Usually non-displaced and stable
  • Transverse fracture
    • Evaluate for angulation/displacement
  • Intraarticular fracture


General Fracture Management

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

Prophylactic antibiotics are NOT indicated despite open phalangeal finger fracture if:

  • Fractures is metacarpophalangeal joint (i.e. Tuft fracture)
  • Intact digital arteries


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

See Also