Difference between revisions of "Finger (phalanx) fracture"

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==[[Proximal Finger Phalanx Fracture]]==
 
==[[Proximal Finger Phalanx Fracture]]==
===Examination===
 
* Examine the phalanx with the fingers in full extension and flexion
 
* Assess for malrotation
 
 
===Imaging===
 
* AP, lateral, oblique
 
** Examine for rotation, shortening, angulation
 
 
===Treatment===
 
* If requires ortho referral: Radial or ulnar gutter splint
 
* Nondisplaced, stable: Consider buddy taping the injured finger to an adjacent finger
 
** If the ring finger is involved it should be buddy taped to the little finger
 
* Displaced or angulated fx
 
** Consider closed reduction
 
*** After reduction ensure that PIP joint is in extension, MCP is in flexion (to avoid contracture)
 
 
===Disposition===
 
* Refer for:
 
** Intraarticular
 
** Unstable
 
*** Spiral or oblique fx
 
*** Condylar fx
 
*** Neck fx
 
*** Large avulsion fx
 
** Rotated
 
*** NO degree of rotation is acceptable following a reduction
 
** Shortened
 
** Significantly angulated
 
*** Less than 10 degrees may be tolerated
 
  
 
==[[Middle Finger Phalanx Fracture]]==
 
==[[Middle Finger Phalanx Fracture]]==

Revision as of 05:37, 4 January 2014

Background

  • Be wary of avulsion fx of base of phalanx
    • Lateral or medial fracture fragment = collateral ligament avulsion
    • Dorsal fracture fragment = extensor tendon avulsion
    • Palmar fracture fragment = volar plate avulsion
  • Flexion deformity of distal phalanx (mallet/baseball finger) = avulsion fx or extensor tendon rupture

Proximal Finger Phalanx Fracture

Middle Finger Phalanx Fracture

  • Commonly associated with tendon injuries!

Examination

  • Assess PIP, DIP flexion/extension
  • Assess PIP, DIP collateral ligaments (varus/valgus stress)

Images

  • AP, lateral, oblique
  • Oblique and spiral fractures: evaluate for shortening/malrotation

Treatment

  • Nondisplaced without angulation:
    • Buddy tape to adjacent finger
      • Buddy tape ring finger to little finger
    • Dorsal or volar finger splint if desire added protection
  • Displaced or angulated fx
    • Closed reduction
      • Adequate reduction:
        • <1-2mm displacement or shortening
        • Up to 10 degrees of angulation
        • No amount rotation
      • Followed by ulnar or radial gutter splint
        • Wrist in 20-30 degrees of extension
        • MCP joints in 70-90 degrees of flexion
        • PIP and DIP joints flexed 5-10 degrees
          • Decreases the force exerted by the FDS

Dispo

  • Refer for:
    • Comminution
    • Malrotation
    • Intraarticular fx
    • Displaced or angulated fractures that cannot maintain their reduction
    • Most spiral and oblique fx (usually involve rotation or shortening and are unstable)

Distal Finger Phalanx Fracture

Examination

  • Evaluate for tendon damage

Imaging

  • Comminuted tuft fx
    • Stable
  • Longitudinal fx
    • Usually non-displaced and stable
  • Transverse fx
    • Evaluate for angulation/displacement
  • Intraarticular fx

Treatment

  • Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
    • Do not attempt to reduce comminuted tuft fx

Dispo

  • Refer for:
    • Tendon dysfunction
    • Nerve dysfunction
    • Displacement or angulation
    • Intraarticular fx

See Also

Source

UpToDate